Single-Axillary-Incision Endoscopic-Assisted Hybrid Technique for Nipple-Sparing Mastectomy: Technique, Preliminary Results, and Patient-Reported Cosmetic Outcome from Preliminary 50 Procedures
- 309 Downloads
A new hybrid technique for single-axillary-incision endoscopic-assisted nipple-sparing mastectomy (E-NSM) was introduced. Preliminary results are reported.
Patients who received single-axillary-incision E-NSM from August 2013 to August 2017 were searched from a single institution. Data were analyzed to determine the effectiveness and oncologic safety of single-axillary-incision E-NSM. Patient-oriented cosmetic outcome report was also obtained.
During the study period, a total of 50 E-NSM with single-incision procedures were performed in 41 female patients with breast cancer, including 11 (26.8%) patients with bilateral disease. Their mean age was 45.3 ± 8.4 years. The mean size of tumors encountered during the 50 single-incision E-NSM procedures was 2.3 ± 1.8 (0.1–7.3) cm for invasive tumors and 2.6 ± 1.7 (0.2–5.7) cm for carcinoma in situ lesions. Six (12%) of those tumors were multifocal/multicentric. Lymph node metastasis was found during 12% of the procedures. Forty-five (90%) received immediate breast reconstruction with gel implant. Mean operating time was 244.3 ± 82.8 min. The overall complication rate was 6%, and no total nipple necrosis or implant loss was observed. No locoregional recurrence or distant metastasis was found during mean follow-up of 21.6 months. About 94.4% of patients were satisfied with the postoperative scar location and wound length. All patients who responded would choose the same operation again.
The proposed single-axillary-incision endoscopic hybrid technique for nipple-sparing mastectomy was a safe procedure with low morbidity and associated with high patient satisfaction.
This study was funded by the Ministry of Science and Technology of Taiwan (no. 104-2314-B-371-006-MY3). This study was also sponsored by research funding provided by Changhua Christian Hospital (105-CCH-IRP-032 and 105-CCH-PRJ-003). The authors would like to thank Yun-Ting Chang, Shu-Hsin Pai, and Shun-Ing Tsai for assistance with this study.
There are no conflicts of interest in this study. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Drs. Lai HW, Lin SL, Kuok KM, Chen SL, Lin YL, Chen DR, and Kuo SJ have no conflicts of interests or financial ties to disclose.
Supplementary material 1 (MP4 32848 kb)
- 3.Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V, et al. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European Institute of Oncology of Milan (EIO). Breast Cancer Res Treat. 2009, 117(2):333–338.CrossRefPubMedGoogle Scholar
- 8.Lai HW, Chen ST, Chen DR, Chen SL, Chang TW, Kuo SJ, Kuo YL, Hung CS. Current trends in and indications for endoscopy-assisted breast surgery for breast cancer: results from a six-year study conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group. PLoS ONE. 2016, 11(3):e0150310.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Lai HW, Wu HS, Chuang KL, Chen DR, Chang TW, Kuo SJ, Chen ST, Kuo YL. Endoscopy-assisted total mastectomy followed by immediate pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction: preliminary results of 48 patients. Surg Innov. 2015, 22(4):382–389.CrossRefPubMedGoogle Scholar
- 17.Fan LJ, Jiang J, Yang XH, Zhang Y, Li XG, Chen XC, Zhong L. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer. Chin Med J (Engl). 2009, 122(24):2945–2950.Google Scholar
- 26.Chan SE, Liao CY, Wang TY, Chen ST, Chen DR, Lin YJ, Chen CJ, Wu HK, Chen SL, Kuo SJ, et al. The diagnostic utility of preoperative breast magnetic resonance imaging (MRI) and/or intraoperative sub-nipple biopsy in nipple-sparing mastectomy. Eur J Surg Oncol. 2017, 43(1):76–84.CrossRefPubMedGoogle Scholar
- 27.Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ. Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011, 22(8):1736–1747.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.NCCN Clinical Practice Guidelines in Oncology-Breast Cancer. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf.