An Insight into Feasibility and Safety of Endoscopic Nipple Sparing Mastectomy Technique

The latest recommendations suggest prophylactic mastectomy for women over 30 with augmented risk of breast cancer, Bilateral mastectomy can be performed using a variety of surgical procedures, either with or without breast reconstruction. This study is aimed to assess the feasibility of the  Endoscopic Nipple Sparing Mastectomy (E-NSM) technique performed without robotic assistance, using a single axillary incision and immediate reconstruction with a prepectoral prosthesis for prophylactic purposes. Secondary goal included assessing postoperative complication risks and aesthetic outcomes.

This prospective, single-center interventional clinical study included a final enrollment of 20 patients. The primary endpoint was the rate of complete surgical procedures performed using E-NSM. Secondary endpoints included the rates of conversion to conventional surgery, infections, hematomas, skin injuries, pain, and aesthetic outcomes as measured by the Breast-Q questionnaire and any additional cosmetic procedures.

The results demonstrated the following:

• A total of 10 patients underwent 19 procedures (9 bilateral mastectomies and 1 unilateral) from April 2019 to June 2022.
• All surgeries were completed successfully without the need for conversion to conventional methods. 
• The complication rate requiring revision surgery was 16% (including 1 case of skin necrosis, 1 postoperative hematoma, and 1 surgical site infection).
• No prosthesis was removed, and the seroma rate was 5%.
• All patients expressed willingness to endorse this technique and reported high satisfaction with the aesthetic results.
• Additionally, 50% of patients required a follow-up cosmetic procedure (lipofilling).

Thus, it can be summarized that these preliminary findings support the feasibility and safety of the E-NSM technique. Further validation in a larger cohort with longer follow-up is necessary to confirm these results.

Source: Rathat G, Chaumette M, Fontaine V, Rebel L, Pissarra J, Duflos C, Duraes M. Endoscopic prophylactic nipple-sparing mastectomy: First French survey of 10 patients. J Gynecol Obstet Hum Reprod. 2024 Oct 10;54(1):102862. doi: 10.1016/j.jogoh.2024.102862. Epub ahead of print. PMID: 39393530.