Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction

Abstract

Purpose: Single-incision videoendoscopic surgery has recently become popular as a result of the ongoing search for less invasive procedures. The aim of this study was to evaluate the safety and efficacy of endoscopic single-port nipple-sparing mastectomy, axillary lymphadenectomy, and immediate reconstruction in patients with breast cancer.

Patients and methods: From May 14, 2012 through January 23, 2013, 10 patients underwent videoendoscopic single-port nipple-sparing mastectomy and axillary dissection via a single, limited incision and immediate prosthetic reconstruction. Patient charts were reviewed, and demographic data, operative time, complications and pathology results were analyzed.

Results: In all patients, videoendoscopic surgery was performed successfully. Of 10 patients, 7 were diagnosed as having invasive ductal carcinoma, 2 had a ductal carcinoma in situ, and 1 underwent bilateral prophylactic mastectomy. The weight of the resected gland was 300-650 g, with a mean of 420 g. There were no operative complications, and the mean operative time was 250 minutes (range, 160-330 minutes). One-stage reconstruction with implants was performed on 4 patients, whereas expanders were placed in the remaining 6. Surgical margins of all cases were pathologically negative, and there were no recurrences observed during the early follow-up period.

Conclusions: Videoendoscopic single-port nipple-sparing mastectomy is technically feasible even in larger breasts, enabling immediate reconstruction with good cosmetic outcomes. However, further studies with larger clinical series and long-term follow-up are required to compare the safety and efficacy of the technique with those of the standard nipple-sparing mastectomy.

FIG. 1.

Photograph showing the bimanual dissection of the nipple to effectively core out the ductal extensions.

FIG. 2.

Operative photograph taken after the completion of gland resection.

FIG. 3.

(Upper panels) Photographs showing a patient with invasive ductal carcinoma of the right breast. (Lower panels) Three weeks after videoendoscopic nipple-sparing mastectomy of the right breast and immediate insertion of a 450-mL expander.

FIG. 4.

Invasive ductal carcinoma of the right breast: nipple sloughing at 1 week following videoendoscopic nipple-sparing mastectomy and immediate insertion of a 650-mL expander.