Single‑port endoscopic nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer: a retrospective single-center study of 167 cases
This retrospective study of 167 breast cancer patients demonstrates that single-port endoscopic nipple-sparing mastectomy combined with prosthesis breast reconstruction is a safe, feasible, and oncologically sound technique that offers concealed incisions and high patient satisfaction with cosmetic outcomes.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many women facing a breast cancer diagnosis, the path to healing involves removing the breast tissue to eliminate the disease. While this life-saving step is often necessary, the physical absence of a breast can carry a heavy psychological weight, altering how a person sees themselves and interacts with the world. In recent years, surgeons have developed ways to remove the cancerous tissue while preserving the natural skin envelope and the nipple, a technique known as nipple-sparing mastectomy. This approach, often paired with immediate reconstruction using an implant, aims to restore the body's form without sacrificing the safety of the cancer treatment. However, traditional methods of performing this surgery usually require visible cuts across the chest, which can leave noticeable scars and sometimes compromise the delicate blood supply needed to keep the skin and nipple healthy.
A team of surgeons at Hunan Cancer Hospital in China set out to refine this process by combining the preservation of the nipple with a minimally invasive approach. They utilized a single-port endoscopic technique, which involves inserting surgical instruments through a tiny, hidden incision in the armpit rather than cutting across the breast itself. This method allows the surgeon to work inside the chest cavity under the guidance of a camera, removing the glandular tissue while leaving the overlying skin and nipple untouched. The researchers wanted to know if this more complex, hidden-scar approach was safe, effective, and capable of producing beautiful results without increasing the risk of complications or cancer recurrence.
The study followed 167 women who underwent this specific procedure between March 2023 and December 2024. All of these patients had early-stage breast cancer or a pre-cancerous condition where the tumor had not invaded the skin or chest wall. The surgeons performed the mastectomy through a small opening in the armpit, using a camera and specialized tools to carefully separate and remove the breast tissue. Once the tissue was gone, they immediately placed a silicone implant to recreate the breast shape. To ensure the new breast looked natural and matched the other side, they used a mesh material to support the implant and carefully adjusted its position. The entire process was monitored closely, with the team tracking how long the surgeries took, what complications arose, and how the patients looked and felt afterward.
The results showed that this approach is both safe and feasible for the right candidates. The average surgery for one breast took about 224 minutes, while surgeries for both breasts took roughly 371 minutes. The implants used had an average volume of about 254 milliliters. While any surgery carries risks, the overall complication rate in this group was 16.8 percent. The most common issue was a small amount of fluid collecting under the skin, which occurred in 7.2 percent of patients and was easily managed. Infection rates were low at 3 percent, and the loss of the nipple or skin flaps was rare, affecting only a small fraction of the group. Crucially, the study found that the cancer did not return in the vast majority of patients during the follow-up period, which averaged 29 months. Only two patients experienced a recurrence: one had a local return of the cancer, and another developed a distant spread to the brain.
Perhaps the most striking finding was the cosmetic outcome. Because the incision was hidden in the armpit, the breast itself remained free of visible scars. When independent experts reviewed photographs of the patients one year after surgery, 94.6 percent were rated as having excellent or good results. A computer program designed to measure symmetry and color also gave high marks to 95.8 percent of the cases. The patients reported high satisfaction, noting that the surgical scar was naturally concealed and almost invisible. The study suggests that for women with smaller to moderate-sized breasts and tumors that have not spread to the skin, this single-port endoscopic method offers a way to treat cancer effectively while preserving a natural appearance.
The researchers acknowledged that their study had limitations, such as being a single-center report without a direct comparison group and having a follow-up period that was shorter than the decades often needed to fully assess cancer survival. They also noted that the technique requires significant skill and training, as the surgeons' performance improved over time, with later cases taking less time than the first ones. Despite these factors, the data indicates that this minimally invasive technique provides a viable alternative to traditional open surgery. It offers a way to remove breast cancer with the same oncological safety while delivering a superior cosmetic result, giving patients a chance to heal their bodies without the visible reminder of the operation.
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