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

Lai, Hung-Wen; Lin, Shih-Lung; Chen, Shou‐Tung; Kuok, Ka-Man; Chen, Shu‐Ling; Lin, Ya-Ling; Chen, Dar‐Ren; Kuo, Shou‐Jen

doi:10.1245/s10434-018-6383-z

Cited by 49 publications

(46 citation statements)

References 29 publications

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“…New and less invasive approaches are currently being evaluated. For example, a single-axillary-incision endoscopic hybrid technique was safe and associated with low morbidity and high patient satisfaction in an early patient series from Taiwan [ 40 ]. This hidden incision type can also be used for robotic assisted techniques that have the potential to further improve patient satisfaction although these techniques are not widely practiced at present [ 41 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Weber

Haug

Kurzeder

et al. 2018

Breast Cancer Res Treat

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PurposeIndications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.MethodsThe panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.ResultsConsensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.ConclusionsIn case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Weber

Haug

Kurzeder

et al. 2018

Breast Cancer Res Treat

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“…As consequence, the recent trends are to move the access far from the breast footprint in the search for the ideal incision for NSM. [5][6][7][8][9][10][11][12] We believe that the ideal NSM incision is the axillary one as this single access allows to perform a safe nonendoscopic mastectomy in cup A and B breasts, sentinel node biopsy/axillary clearance, and nonendoscopic immediate prepectoral reconstruction when feasible (ie thick skin flaps) or endoscopic submuscular-subfascial direct-toimplant reconstruction, with the main advantage of a hidden and well-concealed scar. In our experience, a 6-cm incision located on the lowest axillary fold along the mid-axillary line allows to perform a safe nonendoscopic mastectomy, node surgery, and direct-to-implant reconstruction both submuscular and prepectoral.…”

Section: Discussionmentioning

confidence: 99%

Nipple‐sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique

et al. 2019

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Introduction Nipple‐sparing mastectomy (NSM) has known an exponential diffusion worldwide for prophilaxis and therapeutic mastectomies in selected candidates, being oncologically safe and improving reconstructive outcomes and patients' satisfaction. The two most common used skin incisions are the radial and inframammary fold ones, which represent an imperfect aesthetic solution. The aim of this work was to give insights on our surgical technique, which allows to perform the NSM, node surgery, and endoscopic direct‐to‐implant reconstruction using a cosmetic axillary incision. Materials and methods Between June 2016 and January 2019, 7 consecutive patients underwent NSM, lymph node surgery and endoscopic direct‐to‐implant reconstruction using a small cosmetic axillary incision for breast cancer treatment in a single Institution. An operative rigid endoscope with working channel (Richard Wolf) was used to dissect the entire submuscular‐subfascial pocket. The mean age of the patients was 42.8 years old (range: 36‐49 years). The evaluation methods were clinical and photography‐based assessments, as well as the BREAST‐Q which was used to quantify patient satisfaction. Results The average follow‐up time was 9 months (range 3‐22 months). Tumor‐free margins were obtained in all cases. No tumor recurrence or metastasis occurred during follow‐up. No major complications were experienced. There were no cases of malposition, wrinkling, or rippling. All patients were satisfied with their esthetic results, especially the absence of visible scars. Conclusions From our preliminary experience, NSM combined with endoscopic immediate reconstruction via axillary incision for breast cancer treatment seems to be a promising new procedure in cup A and B breasts alternative to the conventional techniques, as it allowed to have safe and pleasant aesthetic and oncologic outcomes.

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“…With the help of endoscopic technique, NSM can be performed through a single axillary incision made for axillary surgery, which is able to significantly minimize the scarring on the breast (endoscopic nipple sparing mastectomy, ENSM technique). Lai et al [19] reported their preliminary results of ENSM, suggesting its oncological safety while Du et al [20] reported in a prospective non-randomized study that patients who underwent ENSM were more satisfied with their cosmetic outcomes as compared to those who underwent the traditional BCS.…”

Section: Scarless Strategy In Volume Replacement Approachmentioning

confidence: 99%

In pursuit of a flawless aphrodite: paving the way to scarless oncoplastic breast surgery

Zhu

Tan

et al. 2019

Cancer Commun

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

Abstract: 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.

Cited by 49 publications

References 29 publications

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Nipple‐sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique

In pursuit of a flawless aphrodite: paving the way to scarless oncoplastic breast surgery

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