The Learning Curve of Transaxillary Endoscopy-Assisted Nipple-Sparing Mastectomy With Immediate Prepectoral...

In recent years, endoscopic-assisted techniques have seen accelerated adoption in breast surgery, particularly in the context of mastectomy and subsequent reconstruction procedures. Due to the higher surgical difficulty and longer operation time, it is still not the mainstream of breast surgery. We aimed to evaluate the learning curve of transaxillary endoscopy-assisted nipple-sparing mastectomy (E-NSM) combined with immediate prepectoral implant-based breast reconstruction (IBBR), and the specifics of this technique were elaborated in this study.

From May 2022 to August 2024, patients who underwent transaxillary E-NSM with immediate prepectoral IBBR by the same surgeon at our hospital were enrolled in this study. Operative time trends were assessed using cumulative sum (CUSUM) analysis to characterize the learning curve.

43 procedures performed on 40 patients were included in our analysis. Based on CUSUM analysis, the learning curve of the operative time began to decline consistently after 17 procedures. The operation time decreased significantly from 244.5 ± 9.4 min in learning phase to 153.4 ± 38.4 min in mature phase (p < 0.001). one (2.5%) patient had partial nipple ischemia, two (5.0%) had skin blister formation, one (2.5%) patient had skin flap necrosis. 6 (15.0%) patients had seroma needing aspiration. During the 24-month median follow-up, neither implant loss nor local recurrence was observed.

Transaxillary E-NSM with immediate prepectoral IBBR is a safe and effective technique. About 17 procedures are needed to reach the proficient level.