The Learning Curve of Reverse-Sequence Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant...

The reverse-sequence endoscopic nipple-sparing mastectomy with immediate prepectoral implant reconstruction (RSEM-IPI) has been described as a safe and feasible procedure for early-stage breast cancer. The aim of this study was to evaluate the learning curve for RSEM-IPI.

Between January 2023 and February 2024, we collected data on 104 consecutive patients who underwent RSEM-IPI at our hospital (53 for group 1 and 51 for group 2). The surgeons in group 1 completed the endoscopic training and assistance, whereas the surgeons in group 2 did not. The learning curve was analyzed using the cumulative sum (CUSUM) method to assess changes in the operative times across the case sequence.

Among the 281 patients who received breast reconstruction surgeries, a total of 104 consecutive data were recorded and eligible. Both groups had higher rates of postoperative complications including bleeding, nipple-areolar complex (NAC) ischemia, skin ischemia, infection and longer drainage duration during the phrase 1 compared to the phrase 2. Notably, in terms of the most severe postoperative complications, implant expose and loss, both groups exhibited higher rates during the phrase 1. Breast-Q scores for group 1 in phases 1 and 2 were 66 and 84, respectively, while for group 2, they were 67 and 80. As compared with surgeons in group 2, well-trained surgeons in group 1 were more accessible for stable learning curve with fewer training patients (18 patients) and relatively lower rate of postoperative complications (p > 0.05).

The estimated learning curve for RSEM-IPI was achieved after 18 cases in the well-trained surgeon group. The endoscopic training and assistance were critical to master the breast endoscopic surgeries for breast surgeons.