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

Abstract

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.

Scarless preventive surgery

“…As previously described, 7 this approach can be performed by single site endoscopy, without robotic assistance, freeing us from the economic and accessibility constraints associated with the robotic solution.…”

To acellular dermal matrix or not to acellular dermal matrix?—outcomes of pre-pectoral prosthetic reconstruction after nipple-sparing mastectomy with and without acellular dermal matrix

“…Previous studies have analyzed ADM use in immediate prosthetic reconstruction without controlling for plane of implant placement or solely analyzed outcomes by plane of implant placement without controlling for use of ADM ( 5 , 19 - 25 ). The existing reports analyzing ADM use in pre-pectoral breast reconstruction after NSM, are low powered, allowing for less accurate outcome profiles ( 26 - 30 ). We hypothesized that in pre-pectoral breast reconstruction after NSM, ADM use will result in less post-operative complications compared to no-ADM. We present this article in accordance with the STROBE reporting checklist (available at https://gs.amegroups.com/article/view/10.21037/gs-24-23/rc ).…”

Mastectomy with Reconstruction Including Robotic Endoscopic Surgery (MARRES): a prospective cohort study of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG) and Korean Breast Cancer Study Group (KBCSG)

“…Indications and contraindications for EABS are similar to CNSM. Although ENSM is considered a safe and feasible procedure that leaves a relatively inconspicuous incision in patients with breast cancer [ 38 ], endoscopic techniques for breast surgery have not been widely performed because of the technical challenges with using rigid instruments [ 39 ].…”