Transaxillary Nipple-Sparing Mastectomy, Lymphadenectomy and Direct-to-Implant Submuscular Breast Reconstruction Using Endoscopic Technique: A Step toward the "Aesthetic Mastectomy"

Perioperative care of nipple-areola complex-sparing mastectomy and one-stage breast reconstruction via endoscopic axillary approach for ductal carcinoma in situ: A case report

RATIONALE

Breast cancer represents a prevalent malignancy that primarily impacts women, with pronounced consequences on their overarching health. The major therapeutic approach, encompassing surgical procedures, can often culminate in mastectomy, potentially inciting psychological turmoil and disorders.

PATIENT CONCERNS

A patient was admitted to our facility on May 5, 2023, precipitated by the discovery of bilateral breast masses during a routine physical examination conducted 3 days before admission.

DIAGNOSIS

The breasts were symmetric, with the right nipple inverted and a palpable mass in the upper outer quadrant of the right breast, measuring approximately 5 cm × 4 cm. The mass was firm with indistinct borders, relatively regular morphology, poor mobility, and no tenderness. Outpatient color Doppler ultrasound revealed heterogeneous echogenicity in the right breast, classified as Breast Imaging Reporting and Data System (BI-RADS) category 0, along with multiple ductal dilatations. The left breast exhibited a hypoechoic area (BI-RADS 3), indicative of proliferative changes. Radiographic mammography confirmed diffuse changes in the right breast (BI-RADS 0) and proliferative signs in the left breast (BI-RADS 2). Biopsy results reveal significant atypical ductal hyperplasia consistent with intermediate-grade ductal carcinoma in situ. This patient was diagnosed as ductal carcinoma in situ of the right breast (cTisN0M0 and Stage 0), accompanied by a left breast mass.

INTERVENTIONS

On May 15, 2023, the patient was readmitted for further surgical intervention. Following relevant auxiliary examinations, the patient underwent nipple-areola complex-sparing radical mastectomy for the right breast, sentinel lymph node biopsy in the right axillary area, prosthesis-based breast reconstruction for the right breast, and microrotatotomy of the left breast mass on the left side on May 17.

OUTCOMES

The patient made a successful recovery under scrupulous perioperative supervision and was discharged 7 days post-surgery.

LESSONS

The axillary approach for endoscopic mammary gland excision and immediate implant reconstruction permits patients to preserve the esthetics of the female form while undergoing conventional medical treatment. This methodology considerably enhances the psychophysical health of the patients, thereby marking it as an advantageous practice worthy of broad dissemination in the medical community.

Transaxillary Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction Using a Simplified Endoscopic Approach: Indications, Cosmetic Outcomes and Technical Refinements

BACKGROUND

The increasing demand for further aesthetic outcome improvement in implant-based breast reconstruction after nipple-sparing mastectomy (NSM) leads to major novelties, including endoscopic and robotic NSM with the aim to limit scar visibility. In this paper, we report our experience with a novel and simplified surgical approach-single-axillary-incision non-endoscopic NSM and node surgery followed by an endoscopic DTI breast reconstruction-by focusing on reconstructive indications, technical refinements and aesthetic outcomes.

METHODS

Between June 2016 and October 2019, 14 women underwent this novel technique using definitive anatomical silicone gel filled, totaling 20 breasts. Reconstructive evaluation methods were clinically and photography-based assessment. Breast-Q has been used to quantify patient satisfaction. Feasibility and safety data are also provided.

RESULTS

The average follow-up time was 11 months (range 3-42 months). No local-regional recurrence occurred during follow-up. Median operation time was 340 min; mean hospital stay was 4.1 days. The average mastectomy specimen weight was on average 139 g (ranging from 98 to 182 g). The average implant volume for the reconstructed side was 306 cc (ranging from 165 to 550 cc). Patients' satisfaction was high to very high.

CONCLUSION

Authors' experience suggests that non-endoscopic transaxillary NSM, node surgery and endoscopic direct-to-implant breast reconstruction is a valid, oncological safe, aesthetically sound scarless option in breast cancer patients with small to moderate breast size. It should represent the incision of choice in patient with previous breast surgery with scars that may compromise flap/NAC vascularity using traditional NSM incisions.

LEVEL OF EVIDENCE IV

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