Minimal-access Nipple-sparing Mastectomy With Prepectoral Direct-to-implant Breast Reconstruction Without Acellular...

Minimal-access nipple-sparing mastectomy (MA-NSM), endoscopic-assisted NSM, or robotic-assisted NSM with direct-to-implant breast reconstruction (DTIBR) is increasingly performed due to its small and inconspicuous scars and improved aesthetic results. MA-NSM with prepectoral implant placement without acellular dermal matrix (ADM) or synthetic mesh may offer acceptable outcomes with reduced costs. This study reports the preliminary results of these procedures.

We retrospectively reviewed patients who underwent MA-NSM with prepectoral DTIBR without ADM or synthetic mesh between January and September 2024 using a prospectively maintained database. The clinical results, complications, and patient-reported outcome measurements were analyzed.

Twelve patients underwent 14 MA-NSM procedures with prepectoral DTIBR without ADM or synthetic mesh. The median age was 49 years, and 84.6% were early-stage (stage 0-II) breast cancer patients. The mean operative time per breast was 193 ± 43 minutes. The median mastectomy specimen weight was 262.9 g, and the median implant size was 275 mL. There were no major complications such as implant loss or return to theater. Seroma formation requiring multiple aspirations was the most observed event (42.9%). All the patients were satisfied with the aesthetic results.

In the current preliminary study, MA-NSM with prepectoral DTIBR without ADM or synthetic mesh was a feasible procedure and yielded satisfactory aesthetic results. However, more cases and longer follow-up periods are required to ensure long-term safety in future clinical practice.