The endoscopic-assisted triple-plane technique: a technical refinement for complete autologous prosthesis coverage in subpectoral implant-based breast reconstruction.

The triple-plane technique offers complete autologous prosthesis coverage in subpectoral breast reconstruction without requiring mesh. Its integration with endoscopic assistance allows for precise dissection through a concealed incision. Achieving complete implant coverage without mesh in subpectoral reconstruction remains a technical challenge. This study evaluates the feasibility and early outcomes of this novel endoscopic-assisted triple-plane technique. In this prospective case series, we describe and evaluate an integrated approach utilizing a single axillary incision under endoscopic visualization to dissect three anatomical planes: the subpectoral plane (pectoralis major, A-plane), the serratus anterior fascia (B-plane), and the deep superficial fascia (C-plane). These layers are combined to create a mesh-free pocket ensuring complete autologous prosthesis coverage. In our preliminary series, the procedure was successfully performed in 89 patients. The mean operative time was 90.28±14.95 minutes, with an average blood loss of 44.21±13.40 mL. The mean incision length was 5.47±0.52 cm, and the average hospital stay was 7.56±1.78 days. Postoperative breast appearance was rated as excellent in 86 patients (96.63%) and good in 3 patients (3.37%). All patients reported high satisfaction, with BREAST-Q (a validated patient-reported outcome measure for breast surgery) scores ranging from 80 to 100 and a mean score of 87.28. No major perioperative complications, such as prosthesis loss or total flap necrosis, were recorded. The endoscopic-assisted triple-plane technique is a safe and reproducible mesh-free method that combines the benefits of complete autologous coverage with the advantages of minimally invasive surgery. This integrated approach appears to be a promising refinement for subpectoral breast reconstruction, supported by favorable early aesthetic outcomes and high patient satisfaction. These preliminary findings warrant further validation in comparative studies with larger sample sizes and longer follow-up.