A Technique of Endoscopic Nipple-Sparing Mastectomy for Breast Cancer

Wang, Yu; Wu, Jixiang; Guan, Shan

doi:10.4293/jsls.2017.00028

Cited by 17 publications

(13 citation statements)

References 15 publications

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“…Although video-assisted breast surgery is gaining popularity, endoscopic reconstruction after mastectomy is still facing lots of problems such as the endoscopic limitations of small working space, rigid instrumentation and instrument collision [ 13 ], dissociation difficulties caused by falling mammary glands after subcutaneous dissociation, and the fact that prosthesis cavity maintenance can only be achieved by retractors. While the skin-lift system has previously solved the retractor difficulty, uneven forces on the dissected layer still led to poor surgical vision and dissociation difficulties, increased surgery time and reduced surgical performance [ 5 , 7 ]. Thus, endoscopic method is still not a standard surgical option for breast reconstruction after mastectomy [ 6 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic or robotic mastectomy with implant reconstruction is a novel surgical treatment trend that provides better cosmetic outcomes for breast cancer patients [ 3 , 4 ]. It is difficult to build air cavity by many existing methods of endoscopic mastectomy and implant reconstruction, which leads to the requirements of special equipments such as a skin-lift system, longer operative time and relatively more visible scar despite the small incision [ 5 – 7 ]. Moreover, robot-assisted surgery is expensive, [ 8 – 10 ] which brings patients financial burdens.…”

Section: Introductionmentioning

confidence: 99%

“…It is Songbo Zhang and Yanyan Xie have contributed equally to this study. & Zhenggui Du docduzg@163.com difficult to build air cavity by many existing methods of endoscopic mastectomy and implant reconstruction, which leads to the requirements of special equipments such as a skin-lift system, longer operative time and relatively more visible scar despite the small incision [5][6][7]. Moreover, robot-assisted surgery is expensive, [8][9][10] which brings patients financial burdens.…”

Section: Introductionmentioning

confidence: 99%

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Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method

et al. 2021

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Background Although video-assisted breast surgery is gaining popularity, endoscopic reconstruction after mastectomy is still facing lots of problems, bring about that endoscopic method has not yet become a standard procedure for breast cancer reconstruction. Here, we introduce a novel surgical technique of video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction and describe the detailed surgical procedure using this technique. Methods Detailed steps of surgical procedure, the patient characteristics and the mean operative time of this new technique were described in this article. All patients were asked to score their satisfaction with their reconstructed breasts preoperatively, 1 month, 3 months, 6 months and 12 months postoperatively using the BREAST-Q. Results At first, we used our “conventional method” and performed on 10 patients from April 2017 to June 2020; the operative time was 324.80 ± 66.39 minutes. After improving several procedures of the technique, the “optimized method” was performed on 14 cases from July 2020 to November 2020; the operative time decreased to 193.71 ± 28.75 minutes with shortest was 133 minutes; the optimized method was novel and easy to learn and be generalized. Most of the patients were satisfied with the reconstruction results. There was no significant difference between preoperative scores and scores at 3 months, 6 months and 12 months ( p = 0.364). Since there is no wound on the breast dome, no obvious postoperative complications were observed except for one patient presented with infection. Conclusions This new technique has allowed surgeons to achieve excellent and reproducible outcomes in a single-stage procedure and represents an excellent technique for patients who wish to have a scarless and aesthetically pleasing appearance after mastectomy for breast cancer. This article also highlights the mean operative time (193.71 ± 28.75 minutes) that has been made possible with this new technique. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 . Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02527-6.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method

et al. 2021

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“…The eNSM was not significantly adopted in clinical practice because of technical difficulties and slow learning curve [13]. Most of these methods involved 3 incisions which remained visible following surgery [13][14][15][16][17][18][21][22][23]. In 2014, Tukenmez et al described single-port technique but involved a visible scar and sub-pectoral plane IBR [24].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report

et al. 2019

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Unusual setting of medical care Background: Technical innovations allow endoscopic nipple-sparing mastectomy (NSM), which is well tolerated and associated with greater patient satisfaction. Endoscopic technique did not have wide diffusion; many centers have abandoned this technique because of technical challenges. Implant-based reconstruction (IBR) remains the most common form of breast reconstruction. Current techniques involve partial or total coverage of the implant with pectoralis major muscle to prevent exposure or infection. Muscle dissection has functional and cosmetic consequences. Case Report: We present a case of 45-year-old patient presenting with personal history of right breast cancer. The patient requested left prophylactic mastectomy. We used a 4 cm-long single hidden scar on axillary line. Endoscopic nipple-sparing mastectomy was done using a single port with 3 sleeves. Immediate breast reconstruction was performed by inserting a silicon implant in prepectoral plane without Acellular Dermal Matrix (ADM). At 6 months postoperatively, no complication had been reported. The patient was satisfied with the result and no further correction was necessary. Conclusions: Endoscopic surgery is a valuable option for nipple-sparing mastectomy. This method is a less expensive alternative technique to robotic approach. It could enable safe prepectoral IBR without placement of ADM and with lower risk of complications.

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“…The oncological safety of NSM has been established and has both open, endoscopic approaches. The endoscopic mastectomy has various methods: NSM with liposuction, skin lift approach, multiple ports with a periareolar incision, and single incision transaxillary approach . Even though the single incision approach for NSM is cosmetically appealing, the technical difficulties associated with rigid arms of the instruments and limited vision made it cumbersome, and theoretically, the robotic approach gives us a way out of these limitations.…”

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confidence: 99%

Robotic nipple-sparing mastectomy: The first experience from Indian subcontinent

et al. 2018

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Breast cancer is the second most common cancer in the world and it is the leading cancer affecting Indian women. With growing numbers and increasing cosmetic concerns, more and more women are opting for breast conservation surgeries (BCS). However, in patients in whom breast conservation is not possible, skin-sparing (SSM) or nipple-sparing mastectomy (NSM) with reconstruction is the option.Endoscopic approaches came into vogue to combat the cosmetic concerns associated with open NSM but they failed to gain popularity owing to technical difficulties associated. Robotics was introduced as an alternative to endoscopic approach to overcome these limitations. An initial study by Toesca et al 1 showed the feasibility of this approach and this is our first experience of the innovative procedure.A 30-year-old lady with a lump in upper outer quadrant was evaluated and was found to have BIRADS IV lesion with diffuse microcalcification on imaging with no axillary lymphadenopathy.Fine-needle aspiration from the lesion was suggestive of invasive ductal carcinoma, and rest of the routine work up was unremarkable.As the disease was not feasible for BCS and the patient was keen on breast reconstruction, patient was given the option of robotic NSM with reconstruction using an implant. The procedure was done as described by Antonio Toesca in his original series and our experience of witnessing his live surgery. About 3 cm long incision was taken in the midaxillary line ( Figure 1). The incision was deepened, and planes were created using cautery for the insertion of octoport.The flaps were raised to a distance of about 3 cm, octoport was introduced, and insufflation started to a pressure of around 8 mm Hg (Figure 2). DaVinci Si robot was docked from the opposite side, and 12 mm (0 degree) camera was used. The dissection was carried out using a 5 mm spatula on the right arm and bipolar forceps on the left arm. Initial dissection was done in the superficial skin flap, and nipple shave was sent for frozen analysis which was reported negative. The assistant surgeon was at the operating table managing the skin flap thickness and providing necessary input to the surgeon at the console. After the dissection of superficial flap, breast tissue was dissected off the pectoralis major muscle and the specimen was delivered through the above-said incision. The mono port was repositioned, and submuscular plane was created for implant placement.Axillary dissection was carried out through the same incision. After manually placing the implant, subcutaneous and submuscular drains were kept and the incision was closed. Duration of surgery was 5 hours and 30 min, and no skin necrosis was noted. However, there was minimum erythema of skin in lower inner quadrant which settled on its own. The patient was discharged on second postoperative day and had a routine recovery with no morbidity (Figure 3).With the established popularity of robotics in intra-abdominal malignancies, there is a growing trend for usage of robotics in other areas such as oropharyng...

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A Technique of Endoscopic Nipple-Sparing Mastectomy for Breast Cancer

Cited by 17 publications

References 15 publications

Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method

Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method

Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report

Robotic nipple-sparing mastectomy: The first experience from Indian subcontinent

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