Abstract P2-14-12: Endoscopic Nipple-Sparing Mastectomy: A single Institutional Experience of 50 Consecutive Cases
Authors: LEE HYEYOON , Cho Kyusang , CHANG YOUNGWOO , SON GILSOO 
Published: March 2023

Abstract
Purpose: The purpose of this study is to to introduce an early experience of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods and Materials: Between November 2018 and June 2022, 48 female patients with breast cancer, total 50 cases of breast cancer (bilateral breast cancer in 2 patients) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Forty-six patients, total forty-eight cases, underwent breast reconstruction with silicone implant, two patient underwent TRAM reconstruction. Surgical procedures of endoscopic NSM: Patients were placed in a supine position with both upper limbs on arm boards abducted 90 degree. An incision of 5 cm was made along the anterior axillary line from the inferior mammary fold. The sentinel lymph node was excised through the incision. .A workspace for the insertion of a Glove Port (Nelis, Republic of Korea) was created within a radius of 3 cm from the incision, and the subcutaneous tissue flaps were raised. The Glove Port was inserted first into the retromammary space, carbon dioxide (CO2) gas was insufflated, and the pressure was maintained at approximately 7 mmHg. The retromammary space dissection was performed with caution to avoid dissecting the interpectoral space, using an energy device and an endoscopic grasper guided by a flexible endoscope (ENDOEYE FLEX 10 mm, OLYMPUS, Japan). The breast was elevated to the edge of the latissimus dorsi muscle laterally, to the thoracoabdominal aponeurosis inferiorly, to the level of the clavicle superiorly, and to the edge of the sternum medially. After dissecting the retromammary fat plane, the Glove Port was relocated into the subcutaneous space. Skin flap was dissected using an energy device, and the duct beneath the nipple was cut off using endoscopic scissors. The subcutaneous flap was dissected completely along the boundaries of the breast, and the entire breast was removed Results: The patients were 30-55 years old (mean, 43 years). The tumor located at the left breast in 26 cases and at the right breast in 23 cases. The diameter of tumor ranged from 1.5 to 5.2 cm (mean, 3.4 cm). Median operation time was 153 minutes. After operation, nipple necrosis or skin flap necrosis was not observed. No subcutaneous emphysema occurred. There is one tumor involvement to nipple in postoperative pathological examination. So, excision of nipple-areolar-complex was performed 2 weeks after first operation. All patients were followed up 1-43 months (median, 19 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 43 cases of excellent and 7 cases of good. No tumor recurrence or metastasis occurred during follow-up. Conclusion: It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction.
Citation Format: HYEYOON LEE, Kyusang Cho, YOUNGWOO CHANG, GILSOO SON. Endoscopic Nipple-Sparing Mastectomy: A single Institutional Experience of 50 Consecutive Cases [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-12.