Single-port 3-dimensional Videoscope assisted Endoscopic Nipple-sparing Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Reconstruction: Report of Two Cases

Abstract

\n Background: Minimal access surgery has become the mainstreams of breast surgery, and it is applied for benign lesion, partial mastectomy and total mastectomy. Dual axillary-areolar incision was the most frequent surgical approach in the early stage, but single axillary incision hybrid technique was proposed in recent years. Endoscopic nipple sparing mastectomy was usually applicable to patients with small to medium sized breast. Here, we reported two cases of breast cancer patients, who presented with large and ptosis breast, underwent single port 3-dimension (3D) endoscopic nipple sparing mastectomy (E-NSM) followed by pedicled transverse rectus myocutaneous (TRAM) flap breast reconstruction. Case presentation: The first patient was a 42-year-old woman had palpable right breast mass and enlarged axillary lymph nodes for 4 months. Core needle biopsy(CNB) revealed invasive ductal carcinoma of breast and lymph node metastasis. Breast Magnetic Resonance Imaging(MRI) revealed multi-centric masses in right upper breast, about 6.1 cm in size, without nipple and skin invasion, and right axillary lymphadenopathy. Neoadjuvant chemotherapy was suggested, but the patient refused and preferred surgery first. She underwent single-port 3D E-NSM with immediate pedicled TRAM flap reconstruction. The post-operative recovery was uneventful except partial nipple ischemia/necrosis, which recovered after 2 to 3 months of wound care. The second case was a 39-year-old woman had one palpable mass over right breast for one month. CNB showed ductal carcinoma in situ with focal infiltrating ductal carcinoma. MRI revealed multi-focal mass, 8.7 cm in size, without skin or nipple invasion and no lymph node metastasis. NSM was suggested, but she decided to undergo single-port 3D E-NSM with immediate pedicled TRAM flap reconstruction due to previous history of Cesarean section and obese abdomen. The post-operative recovery was uneventful. Conclusion: Single-port 3D E-NSM followed by pedicled TRAM flap reconstruction is a feasible, safe procedure with satisfactory cosmetic outcome. Time-consuming and technical demanding are two limiting factors of this procedure.