Top

Published in:

01-05-2018 | Breast Oncology

Single-Axillary-Incision Endoscopic-Assisted Hybrid Technique for Nipple-Sparing Mastectomy: Technique, Preliminary Results, and Patient-Reported Cosmetic Outcome from Preliminary 50 Procedures

Authors: Hung-Wen Lai, MD, PhD, Shih-Lung Lin, MD, Shou-Tung Chen, MD, Ka-Man Kuok, MD, Shu-Ling Chen, MS, Ya-Ling Lin, BS, Dar-Ren Chen, MD, Shou-Jen Kuo, MD

Published in: Annals of Surgical Oncology | Issue 5/2018

Abstract

Background

A new hybrid technique for single-axillary-incision endoscopic-assisted nipple-sparing mastectomy (E-NSM) was introduced. Preliminary results are reported.

Methods

Patients who received single-axillary-incision E-NSM from August 2013 to August 2017 were searched from a single institution. Data were analyzed to determine the effectiveness and oncologic safety of single-axillary-incision E-NSM. Patient-oriented cosmetic outcome report was also obtained.

Results

During the study period, a total of 50 E-NSM with single-incision procedures were performed in 41 female patients with breast cancer, including 11 (26.8%) patients with bilateral disease. Their mean age was 45.3 ± 8.4 years. The mean size of tumors encountered during the 50 single-incision E-NSM procedures was 2.3 ± 1.8 (0.1–7.3) cm for invasive tumors and 2.6 ± 1.7 (0.2–5.7) cm for carcinoma in situ lesions. Six (12%) of those tumors were multifocal/multicentric. Lymph node metastasis was found during 12% of the procedures. Forty-five (90%) received immediate breast reconstruction with gel implant. Mean operating time was 244.3 ± 82.8 min. The overall complication rate was 6%, and no total nipple necrosis or implant loss was observed. No locoregional recurrence or distant metastasis was found during mean follow-up of 21.6 months. About 94.4% of patients were satisfied with the postoperative scar location and wound length. All patients who responded would choose the same operation again.

Conclusions

The proposed single-axillary-incision endoscopic hybrid technique for nipple-sparing mastectomy was a safe procedure with low morbidity and associated with high patient satisfaction.

Available only for authorised users

Cense HA, Rutgers EJ, Lopes Cardozo M, Van Lanschot JJ. Nipple-sparing mastectomy in breast cancer: a viable option? Eur J Surg Oncol. 2001, 27(6):521–526.CrossRefPubMed

Petit JY, Veronesi U, Luini A, Orecchia R, Rey PC, Martella S, Didier F, De Lorenzi F, Rietjens M, Garusi C, et al. When mastectomy becomes inevitable: the nipple-sparing approach. Breast. 2005, 14(6):527–531.CrossRefPubMed

Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V, et al. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European Institute of Oncology of Milan (EIO). Breast Cancer Res Treat. 2009, 117(2):333–338.CrossRefPubMed

Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R, et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat. 2009, 114(1):97–101.CrossRefPubMed

Crowe JP, Jr., Kim JA, Yetman R, Banbury J, Patrick RJ, Baynes D. Nipple-sparing mastectomy: technique and results of 54 procedures. Arch Surg. 2004, 139(2):148–150.CrossRefPubMed

Carlson GW, Chu CK, Moyer HR, Duggal C, Losken A. Predictors of nipple ischemia after nipple sparing mastectomy. Breast. J 2014, 20(1):69–73.CrossRefPubMed

Endara M, Chen D, Verma K, Nahabedian MY, Spear SL. Breast reconstruction following nipple-sparing mastectomy: a systematic review of the literature with pooled analysis. Plast Reconstr Surg. 2013, 132(5):1043–1054.CrossRefPubMed

Lai HW, Chen ST, Chen DR, Chen SL, Chang TW, Kuo SJ, Kuo YL, Hung CS. 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.CrossRefPubMedPubMedCentral

Lai HW, Wu HS, Chuang KL, Chen DR, Chang TW, Kuo SJ, Chen ST, Kuo YL. 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.CrossRefPubMed

10.

Chirappapha P, Petit JY, Rietjens M, De Lorenzi F, Garusi C, Martella S, Barbieri B, Gottardi A, Andrea M, Giuseppe L, et al. Nipple sparing mastectomy: does breast morphological factor related to necrotic complications? Plastic Reconst Surg Global Open. 2014, 2(1):e99.CrossRef

11.

Lai HW, Lin HY, Chen SL, Chen ST, Chen DR, Kuo SJ. Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures. World J Surg Oncol. 2017, 15(1):19.CrossRefPubMedPubMedCentral

12.

Lee EK, Kook SH, Park YL, Bae WG. Endoscopy-assisted breast-conserving surgery for early breast cancer. World J Surg. 2006, 30(6):957–964.CrossRefPubMed

13.

Nakajima H, Fujiwara I, Mizuta N, Sakaguchi K, Hachimine Y. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue. Ann Surg. 2009, 249(1):91–96.CrossRefPubMed

14.

Sakamoto N, Fukuma E, Higa K, Ozaki S, Sakamoto M, Abe S, Kurihara T, Tozaki M. Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol. 2009, 16(12):3406–3413.CrossRefPubMed

15.

Leff DR, Vashisht R, Yongue G, Keshtgar M, Yang GZ, Darzi A. Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery? Breast Cancer Res Treat. 2011, 125(3):607–625.CrossRefPubMed

16.

Tamaki Y, Sakita I, Miyoshi Y, Sekimoto M, Takiguchi S, Monden M, Noguchi S. Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases. Surg Laparosc Endosc Percutan Tech 2001, 11(6):356–362.CrossRefPubMed

17.

Fan LJ, Jiang J, Yang XH, Zhang Y, Li XG, Chen XC, Zhong L. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer. Chin Med J (Engl). 2009, 122(24):2945–2950.

18.

Kitamura K, Ishida M, Inoue H, Kinoshita J, Hashizume M, Sugimachi K. Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery. 2002, 131(1 Suppl):S324–S329.CrossRefPubMed

19.

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.CrossRefPubMed

20.

Tukenmez M, Ozden BC, Agcaoglu O, Kecer M, Ozmen V, Muslumanoglu M, Igci A. Videoendoscopic single-port nipple-sparing mastectomy and immediate reconstruction. J Laparoendosc Adv Surg Tech A. 2014, 24(2):77–82.CrossRefPubMedPubMedCentral

21.

Nakajima H, Sakaguchi K, Mizuta N, Hachimine T, Ohe S, Sawai K. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother. 2002, 56 Suppl 1:205s–208s.CrossRefPubMed

22.

Ito K, Kanai T, Gomi K, Watanabe T, Ito T, Komatsu A, Fujita T, Amano J. Endoscopic-assisted skin-sparing mastectomy combined with sentinel node biopsy. ANZ J Surg. 2008, 78(10):894–898.CrossRefPubMed

23.

Toesca A, Peradze N, Galimberti V, Manconi A, Intra M, Gentilini O, Sances D, Negri D, Veronesi G, Rietjens M, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg. 2017, 266(2):e28–e30.CrossRefPubMed

24.

Toesca A, Peradze N, Manconi A, Galimberti V, Intra M, Colleoni M, Bonanni B, Curigliano G, Rietjens M, Viale G, et al. Robotic nipple-sparing mastectomy for the treatment of breast cancer: Feasibility and safety study. Breast. 2017, 31:51–56.CrossRefPubMed

25.

Houssami N, Turner R, Morrow M: Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg. 2013, 257(2):249–255.CrossRefPubMed

26.

Chan SE, Liao CY, Wang TY, Chen ST, Chen DR, Lin YJ, Chen CJ, Wu HK, Chen SL, Kuo SJ, et al. The diagnostic utility of preoperative breast magnetic resonance imaging (MRI) and/or intraoperative sub-nipple biopsy in nipple-sparing mastectomy. Eur J Surg Oncol. 2017, 43(1):76–84.CrossRefPubMed

27.

Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ. Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011, 22(8):1736–1747.CrossRefPubMedPubMedCentral

28.

NCCN Clinical Practice Guidelines in Oncology-Breast Cancer. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf.

29.

Ingram D. Is it time for breast cancer surgeons to embrace endoscopic-assisted mastectomy? ANZ J Surg. 2008, 78(10):837–838.CrossRefPubMed

30.

Jensen JA, Orringer JS, Giuliano AE. Nipple-sparing mastectomy in 99 patients with a mean follow-up of 5 years. Ann Surg Oncol. 2011, 18(6):1665–1670.CrossRefPubMed

31.

Algaithy ZK, Petit JY, Lohsiriwat V, Maisonneuve P, Rey PC, Baros N, Lai H, Mulas P, Barbalho DM, Veronesi P, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012, 38(2):125–129.CrossRefPubMed

Title: Single-Axillary-Incision Endoscopic-Assisted Hybrid Technique for Nipple-Sparing Mastectomy: Technique, Preliminary Results, and Patient-Reported Cosmetic Outcome from Preliminary 50 Procedures
Authors: Hung-Wen Lai, MD, PhD
Shih-Lung Lin, MD
Shou-Tung Chen, MD
Ka-Man Kuok, MD
Shu-Ling Chen, MS
Ya-Ling Lin, BS
Dar-Ren Chen, MD
Shou-Jen Kuo, MD
Publication date: 01-05-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6383-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single-Axillary-Incision Endoscopic-Assisted Hybrid Technique for Nipple-Sparing Mastectomy: Technique, Preliminary Results, and Patient-Reported Cosmetic Outcome from Preliminary 50 Procedures

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2018

Efficacy of Adjuvant S-1 Versus XELOX Chemotherapy for Patients with Gastric Cancer After D2 Lymph Node Dissection: A Retrospective, Multi-Center Observational Study

Concurrent Versus Sequential Chemoradiation Therapy in Completely Resected Pathologic N2 Non-Small Cell Lung Cancer: Propensity-Matched Analysis of the National Cancer Data Base

4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease

Risk Stratification According to the Prognostic Nutritional Index for Predicting Postoperative Complications After Lung Cancer Surgery

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases From a Small Bowel Adenocarcinoma: Multi-Institutional Experience

Contrast-Enhanced Spectral Mammography is Comparable to MRI in the Assessment of Residual Breast Cancer Following Neoadjuvant Systemic Therapy