Endoscopy assisted total mastectomy with and without immediate reconstruction: an extended follow-up, multi-center study.

BACKGROUND Endoscopic assisted total mastectomy (EATM) has been used for surgical intervention of breast cancer patients, however, large cohort studies with long term follow-up data are lacking. MATERIALS AND METHODS Breast cancer patients who underwent EATM during the period of May 2009 to March 2018 were collected prospectively from multi-centers. Clinical outcome, impact of different phases, oncologic results, and patient-reported aesthetic outcomes of EATM were reported. RESULTS A total of 436 EATM procedures were performed, and 355 (81.4%) were endoscopic assisted nipple sparing mastectomy (E-NSM), and 81(18.6%) were endoscopic assisted skin sparing mastectomy (E-SSM). Three hundred and fourteen (75.4%) of the procedures were associated with immediate breast reconstruction (IBR), and 255 were prothesis based while 59 were associated with autologous flaps. The positive surgical margin rate for EATM was 2.1%. In morbidity evaluation, there were 19 (5.4%) cases with partial nipple necrosis, and 2 (0.6%) cases with total nipple necrosis, and 3 (0.7%) cases had implant loss. Compared with the early phase, surgeons operating on patients in the middle or late phase, had significantly decreased the operation time and blood loss. In patient-reported cosmetic outcomes, about 94.4% were satisfied with the aesthetic results. Patients with breast reconstruction, and preserving the nipple had higher satisfaction rates. Over a median follow-up of 54.1 ± 22.4 months, there were 14 (3.2%) cases of locoregional recurrences, 3 (0.7%) distant metastasis, and 1 (0.2%) mortality. CONCLUSION This multi-centers' study showed that EATM is a reliable surgical intervention for early breast cancer with high patient satisfaction.