Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Zhenqiang ^1,2 , CHEN Kai ² , ZHU Liling ² , ZENG Jianfeng ¹ , ZHOU Zhiping ¹ ,  LI Shunrong ²

1. Department of General Surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China;
2. Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P.R.China;

Corresponding author：

LI Shunrong, Email: lishr@mail.sysu.edu.cn

Keywords：

Breast cancer; nipple-sparing mastectomy; endoscopy; breast reconstruction

DOI：

10.7507/1002-1892.201804027

Video：

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Objective To introduce an surgical technique of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods Between January 2017 and February 2018, 15 female patients with breast cancer (stageⅠ in 5 cases and stage Ⅱ in 10 cases) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. They were 27-45 years old (mean, 37.5 years). The disease duration ranged from 1 to 24 months (mean, 8 months). The tumor located at the left breast in 8 cases and at the right breast in 7 cases. The diameter of tumor ranged from 1.5 to 3.0 cm (mean, 2.6 cm). The distance between tumor and nipple was 1.8-4.0 cm (mean, 2.3 cm). Results After operation, the nipple epidermal necrosis occurred in 1 case, and subcutaneous effusion in 1 case. No subcutaneous emphysema or skin flap necrosis occurred. Postoperative pathological examination showed that 1 case was nipple involvement and was treated with nipple resection. All patients were followed up 7-17 months (mean, 11 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 4 cases of excellent, 10 cases of good, and 1 case of poor. 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： HUANG Zhenqiang, CHEN Kai, ZHU Liling, ZENG Jianfeng, ZHOU Zhiping, LI Shunrong. Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1458-1462. doi: 10.7507/1002-1892.201804027 Copy

1.	Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat, 2009, 118(3): 623-633.
2.	刘宝胤, 丁毅, 骆成玉, 等. 乳腔镜辅助乳腺癌腺体切除假体植入一期成形 17 例报告. 中国现代手术学杂志, 2013, 17(2): 104-107.
3.	张敬, 钟青, 赵长啸, 等. 腔镜辅助下乳晕区小切口皮下全乳腺体切除一期假体植入术. 徐州医学院学报, 2013, 33(10): 673-675.
4.	范林军, 姜军, 杨新华, 等. 全腔镜乳腺癌皮下腺体切除一期假体植入乳房重建. 中国微创外科杂志, 2008, 8(6): 484-487.
5.	杨华伟, 刘剑仑, 唐玮, 等. 全腔镜下保留乳头乳晕皮下腺体切除术的临床应用. 广西医科大学学报, 2013, 30(4): 600-602.
6.	王子函, 滕长胜, 葛智成, 等. 全腔镜乳房皮下腺体切除术加腔镜前哨淋巴结活检术治疗乳腺癌的临床应用. 临床和实验医学杂志, 2015, 14(15): 1297-1301.
7.	佘青, 李有怀, 程永刚, 等. 全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术治疗早中期乳腺癌的技巧探讨. 川北医学院学报, 2016, 31(5): 756-758.
8.	Ahn SJ, Woo TY, Lee DW, et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol, 2018, 44(8): 1170-1176.
9.	Carlson GW, Chu CK, Moyer HR, et al. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J, 2014, 20(1): 69-73.
10.	Ho WS, Ying SY, Chan AC. Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc, 2002, 16(2): 302-306.
11.	Lai HW, Wu HS, Chuang KL, et al. 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.
12.	Lai HW, Chen ST, Chen DR, et al. 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.
13.	蔡小勇, 晏益核, 潘孟. 常规腔镜器械经腋窝入路行单孔乳房纤维腺瘤切除术 1 例报告. 腹腔镜外科杂志, 2012, 17(2): 159-160.
14.	Tukenmez M, Ozden BC, Agcaoglu O, et al. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. Journal of Laparoscopic & Advanced Surgical Techniques, 2014, 24(2): 77-82.
15.	Rossi C, Mingozzi M, Curcio A, et al. Nipple areola complex sparing mastectomy. Gland Surg, 2015, 4(6): 528-540.
16.	Rusby JE, Brachtel EF, Taghian A, et al. George Peters Award. Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy. Am J Surg, 2007, 194(4): 433-437.
17.	Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.

1. Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat, 2009, 118(3): 623-633.
2. 刘宝胤, 丁毅, 骆成玉, 等. 乳腔镜辅助乳腺癌腺体切除假体植入一期成形 17 例报告. 中国现代手术学杂志, 2013, 17(2): 104-107.
3. 张敬, 钟青, 赵长啸, 等. 腔镜辅助下乳晕区小切口皮下全乳腺体切除一期假体植入术. 徐州医学院学报, 2013, 33(10): 673-675.
4. 范林军, 姜军, 杨新华, 等. 全腔镜乳腺癌皮下腺体切除一期假体植入乳房重建. 中国微创外科杂志, 2008, 8(6): 484-487.
5. 杨华伟, 刘剑仑, 唐玮, 等. 全腔镜下保留乳头乳晕皮下腺体切除术的临床应用. 广西医科大学学报, 2013, 30(4): 600-602.
6. 王子函, 滕长胜, 葛智成, 等. 全腔镜乳房皮下腺体切除术加腔镜前哨淋巴结活检术治疗乳腺癌的临床应用. 临床和实验医学杂志, 2015, 14(15): 1297-1301.
7. 佘青, 李有怀, 程永刚, 等. 全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术治疗早中期乳腺癌的技巧探讨. 川北医学院学报, 2016, 31(5): 756-758.
8. Ahn SJ, Woo TY, Lee DW, et al. Nipple-areolar complex ischemia and necrosis in nipple-sparing mastectomy. Eur J Surg Oncol, 2018, 44(8): 1170-1176.
9. Carlson GW, Chu CK, Moyer HR, et al. Predictors of nipple ischemia after nipple sparing mastectomy. Breast J, 2014, 20(1): 69-73.
10. Ho WS, Ying SY, Chan AC. Endoscopic-assisted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc, 2002, 16(2): 302-306.
11. Lai HW, Wu HS, Chuang KL, et al. 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.
12. Lai HW, Chen ST, Chen DR, et al. 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.
13. 蔡小勇, 晏益核, 潘孟. 常规腔镜器械经腋窝入路行单孔乳房纤维腺瘤切除术 1 例报告. 腹腔镜外科杂志, 2012, 17(2): 159-160.
14. Tukenmez M, Ozden BC, Agcaoglu O, et al. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. Journal of Laparoscopic & Advanced Surgical Techniques, 2014, 24(2): 77-82.
15. Rossi C, Mingozzi M, Curcio A, et al. Nipple areola complex sparing mastectomy. Gland Surg, 2015, 4(6): 528-540.
16. Rusby JE, Brachtel EF, Taghian A, et al. George Peters Award. Microscopic anatomy within the nipple: implications for nipple-sparing mastectomy. Am J Surg, 2007, 194(4): 433-437.
17. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision

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