Therapeutic nipple-sparing mastectomy combined with endoscopic immediate prosthetic breast reconstruction via axillary incision. A further step towards evidence-based and personalized surgery.

Introduction: Nipple-sparing mastectomy is an oncologically validated technique for selected breast cancer patients and allows to improve aesthetic results and patients' quality of life. Conventional skin incisions are often a suboptimal solution due to the visibility of the scars. Aim of this work is to show our innovative technique, which allows to perform nipple-sparing mastectomy, lymph-node surgery, and endoscopic immediate prosthetic breast reconstruction using a single cosmetic axillary incision.

Materials And Methods: Between June 2016 and October 2019, 14 consecutive patients underwent therapeutic nipple- sparing mastectomy with endoscopic immediate reconstruction via axillary incision; inclusion criteria were cup A or B breasts and tumors less than 3 cm in diameter. Data were recorded in order to evaluate reproducibility, feasibility, safety, aesthetic outcomes and patients' quality of life.

Results: Mean age was 46 years old (range: 34-54 years); median tumor size was 1.7 cm; average follow-up time was 11 months (range 3-42); median operation time was 340 minutes; mean hospital stay was 4,1 days. Tumor-free margins were obtained in all 14 cases. No local-regional recurrence occurred during follow-up. No major complications were experienced. No systemic complications were observed. All patients were satisfied with their aesthetic results, especially the absence of visible scars.

Conclusions: Therapeutic nipple-sparing mastectomy with endoscopic immediate prosthetic reconstruction via axillary incision is a safe and appropriate procedure in cup A and B breasts, alternative to conventional techniques. It allows to improve aesthetic outcomes and patients' quality of life thanks to a single well-hidden axillary scar.

Key Words: Axillary Incision, Breast Cancer, Endoscopic Breast Reconstruction, Nipple-Sparing Mastectomy, Oncological and Aesthetic Outcomes, Quality of Life.