Early Results of an Endoscopic Nipple-Sparing Mastectomy for Breast Cancer

Abstract

BACKGROUND.: Endoscopic mastectomy has been reportedly associated with smaller scars and greater patient satisfaction; however, few reports on this topic have been made. The purpose of this retrospective study was to examine the early results of endoscopic nipple-sparing mastectomy (ENSM) and to investigate the safety of this procedure. METHODS.: Between January 2002 and December 2005, a total of 87 patients with breast cancer but without skin and nipple involvement, including two cases of bilateral breast cancer, underwent E-NSM. In case of bloody nipple discharge and suspicious extension near the nipple as assessed by magnetic resonance imaging, the major ducts within the nipple were cored (nipple coring). In other cases, nipple coring was not performed. RESULTS.: Of the 89 breasts in 87 patients, 42 had tumors of >2 cm and 80 were diagnosed as having invasive carcinoma. Lymph node involvement was observed in 36 procedures. The overall rate of nipple necrosis was 18% (16 of 89). The rate of nipple necrosis among the procedures with nipple coring was statistically higher than that among those without nipple coring (7 of 17, 41%, vs. 9 of 72, 13%) (P = .01). Nipple involvement was observed in 2.2% (2 of 89). After a median follow-up period of 52 months, distant metastasis was observed in nine cases; no local recurrences occurred in this series. CONCLUSIONS.: E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy. The higher rate of nipple necrosis may have been the result of a technical problem, indicating the need for continued improvement in nipple coring procedures.

Robotic nipple-sparing mastectomy for the treatment of breast cancer: Feasibility and safety study

“…However, the manual control of a two-dimensional endoscopic in-line camera produces an inconsistent optical window around the curvature of the breast skin flap and the internal mobility is limited. Moreover, the dissection angles during endoscopic mastectomy seem inadequate because rigid-tip instruments are working almost in parallel through a single access [8–13]. Because of such technical limits the endoscopic approach to breast surgery has not been significantly adopted in clinical practice.…”

The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study

“…However, breast surgeons are concerned about the residual duct in the nipple, which may increase the chance of local recurrence. According to similar studies on conventional nipple-sparing mastectomies, there is no significant difference in local recurrence when the nipple is preserved [ 8 – 11 ]. In our study, subareolar biopsies were routinely taken during the operation, and the decision on whether or not to preserve the nipple was made based on the results.…”

Present status of endoscopic mastectomy for breast cancer

“…However, most reports show a method to exfoliate breast from the skin through a small incision using an abrasion device with an endoscope, the retractor with the endoscope, and the appliance that exfoliates with a balloon under endoscopic observation. For an endoscope with an abrasion device, a vein abrasion retractor with a 30° endoscope [6][7][8][9] or optical tracker [10] is used, and for a retractor with the endoscope, an Ultra Retractor (Johnson and Johnson Company, New Brunswick, NJ) [11,12] or Optical Retractor (Karl Storz GmbH and Co. KG, Tuttlingen, Germany) [11] with a 30° endoscope is used.…”

“…The semi-ark incision is placed in the areolar edge, and an abrasion device is used through this wound [14] . Some articles show that both axillary and periareolar incisions are used as windows for manipulating instruments [1,[7][8][9]12,13,17] . Most of these reports are from Japan and Korea.…”