Surgical Safety and Risk Factors in 931 Consecutive Trans-axillary Reverse-Sequence Endoscopic Nipple-Sparing Mastectomies: A Retrospective Study.

BACKGROUND

The trans-axillary reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) technique demonstrates advantages in operative efficiency and cosmetic outcomes. This large-scale study evaluated its surgical safety and identified associated risk factors.

METHODS

We retrospectively analyzed clinical data from patients undergoing R-E-NSM between May 2020 and September 2023. Multivariable logistic regression identified independent risk factors for complications.

RESULTS

The analysis included 931 R-E-NSM procedures in 727 patients. Breast reconstruction was performed in 618 (85.00%) cases. The overall complication rate was 14.31%, with major complications occurring in 2.20% of cases. A breast cup size of D or larger was an independent risk factor for major complications (OR, 16.00; 95% CI, 1.89-135.2; P = 0.01). Independent risk factors for any complication included breast ptosis (Grade I: OR, 1.96; 95% CI, 1.13-3.43; P = 0.02; Grade II: OR, 1.77; 95% CI, 1.01-3.90; P = 0.046) and adjuvant chemotherapy (ACT) (OR, 1.76; 95% CI: 1.05-2.96; P = 0.03). Independent risk factors for surgical site infection were prepectoral implant-based breast reconstruction (IBBR) (OR, 4.62; 95% CI, 1.04-20.59; P = 0.045), dual-plane IBBR (OR, 6.87; 95% CI, 1.55-30.45; P = 0.01), and ACT (OR, 2.15; 95% CI, 1.08-4.28; P = 0.03). Late cosmetic revisions occurred in 1.54% of patients. At a median follow-up of 30.20 months, locoregional recurrence and distant metastasis rates were both 1.00%.

CONCLUSIONS

R-E-NSM is a safe option for treating benign and malignant breast diseases. Special consideration is warranted for patients with larger breast volume (cup size ≥D). Long-term comparative studies are needed to further validate its role.