Single‑port endoscopic nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer: a retrospective single-center study of 167 cases

Background Single‑port endoscopic nipple-sparing mastectomy combined with prosthetic breast reconstruction (E-NSM-PBR) has been used for breast repair due to aesthetic considerations. However, the clinical feasibility, postoperative complications and oncological safety of E-NSM-PBR in breast surgery remain controversial. This study presents our experience with the application of E-NSM-PBR in breast cancer patients and reports the preliminary results. Methods This is a retrospective study of 167 patients who underwent breast surgery using E-NSM-PBR at our institution between March 1, 2023 and December 31, 2024. Their clinicopathological characteristics, postoperative complications, cosmetic outcomes, and oncologic outcomes were analyzed. Results All patients underwent nipple-sparing mastectomy under single-port endoscopy, followed by breast prosthesis reconstruction. The average duration of unilateral surgery is 222.9 minutes (ranging from 115 to 537 minutes). The average operation time on both sides was 371 minutes (ranging from 348 to 390 minutes). The average reconstruction volume was 253.6 ml (ranging from 100 to 445 ml). The overall complication rate was 16.8%. The subcutaneous fluid and infection in the breast area are the most common complications in breast reconstruction, with a total of 18 cases (10.2%). The combined necrosis rate of the nipple-areola complex (NAC) and skin flaps is 3.6%. There were 3 cases of implant loss after postoperative radiotherapy. The incidence of bleeding complications was the lowest, only 1.2%. Cosmetic outcomes were satisfactory in 94.6% of patients on a four-point scale by three-panel assessment and 95.8% using the BCCT.core software. After a median follow-up of 29 months, one local and one systemic recurrence were observed. Conclusions E-NSM-PBR is a safe and feasible immediate breast reconstruction technique with concealed surgical incision and promising oncologic safety. For suitable candidates, E-NSM-PBR technology can provide good cosmetic results.