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

Abstract

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.

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

“…In this study, we presented a novel endoscopic technique for NSM and LD harvesting through a single axillary incision [endoscopic NSM has been described previously ( 20 , 21 )] and compared it to the TET and open surgery in terms of short-term surgical outcomes. As the ET (both the NET and TET) share some similarities in terms of manipulation, and the aesthetic effect and QoL of the breast cancer patients undergoing BR are greatly affected by the length and position of the incisions (the incision of the 2 endoscopic techniques are similar), we also compared all the outcome measures between the ET and the OPEN groups.…”

“…The surgical technique for NSM and the concept of the “HUAXI hole 1” has been described previously ( 20 , 21 ). The retro-areolar tissue should be carefully dissected by surgical scissors to protect the blood supply and prevent nipple ischemia.…”

“…Next, NSM was performed in the order of the subpectoral space (if an implant was placed in the subpectoral position, by a coagulation hook), retromammary space (by a coagulation hook with the assistance of forceps), and the subcutaneous layer of breast, which was dissected using the PMOD to retro-areolar tissue under direct vision, and the rest of the layer was then performed using the PMOD inserted through the "HUAXI hole 1" (located next to the areola in the upper-outer quadrant) (see Figure 2C). The surgical technique for NSM and the concept of the "HUAXI hole 1" has been described previously (20,21). The retro-areolar tissue should be carefully dissected by surgical scissors to protect the blood supply and prevent nipple ischemia.…”

Trans-axillary single port insufflation technique-assisted endoscopic surgery for breast diseases: Clinic experience, cosmetic outcome and oncologic result

“…However, even with such a small incision, ischemic and necrosis of the NAC may still occur in some patients who are prone to ischemia or necrosis, including elderly patients, women with breast enlargement or prolapse, and patients with a history of smoking or previous radiation exposure ( 28 ). To solve such problems, Du and his team ( 29 ) creatively created Huaxi No.1 foramen around the areola to reduce the possibility of ischemic necrosis of NAC and the difficulty of the operation.…”

Endoscopic Nipple- or Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Endoscopic Harvesting of the Latissimus Dorsi Flap: A Preliminary Experience of an Innovative Technique

“…Then, E-N/SSM was performed in the order of the retro mammary space (by electric knife and a coagulation hook) and the subcutaneous layer of the breast, which was dissected using the electric knife to retro-areolar tissue through the axillary incision, and the rest of the layer was then performed using the electric knife inserted through the “HUAXI hole 1” (located next to the areola in the upper-outer quadrant). The surgical procedure was detailed in primary studies [ 18 , 19 ].…”