Dual-Plane versus Endoscopic Latissimus Dorsi Muscle Flap Breast Reconstruction after Endoscopic Nipple-Sparing Mastectomy.

BACKGROUND

The authors developed an innovative integrated approach combining reverse-sequence endoscopic nipple-sparing mastectomy with reverse-sequence endoscopic latissimus dorsi muscle flap (R-E-LDMF) harvest for breast reconstruction (BR) through a discreet axillary incision. Both techniques demonstrate clinical feasibility, but no systematic comparison of patient-reported outcomes, complications, and cost efficiency between endoscopic implant-based BR and R-E-LDMF BR exists.

METHODS

A prospective, 2-center cohort study was conducted from July of 2021 through March of 2024, enrolling patients with breast cancer who underwent reverse-sequence endoscopic nipple-sparing mastectomy followed by either dual-plane BR or R-E-LDMF BR. The primary end point was patient-reported outcomes assessed using the BREAST-Q reconstruction module (focusing on satisfaction with breasts and quality of life). Other end points included clinical outcomes, complications, and oncologic outcomes.

RESULTS

Among 191 enrolled patients (41 R-E-LDMF versus 150 dual-plane), R-E-LDMF BR required longer operative times but incurred substantially lower hospitalization costs. After controlling for baseline patient characteristics, patients who underwent R-E-LDMF BR had greater satisfaction with their breasts (mean difference, -9.39 [95% CI, -16.97 to -1.80]; P = 0.016) at 1 year compared with patients who underwent dual-plane BR. BREAST-Q scores showed no intergroup differences in quality of life. The R-E-LDMF group had higher rates of any and minor complications. Major complication rates and oncologic outcomes were similar between the 2 groups.

CONCLUSIONS

The R-E-LDMF BR technique achieved aesthetic results and major complication rates comparable to those of the dual-plane approach while significantly reducing overall medical costs, despite higher minor complication rates. This approach represents a cost-effective alternative for patients seeking optimal aesthetic results with reduced financial burden.