A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction - medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients

Sep 21, 2026

Reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) combined with direct-to-implant breast reconstruction (DIBR) has gained rapid adoption, yet evidence on oncologic safety and the practicality of discharging patients within 24 hours remains limited. This single-centre retrospective cohort study compared patients with stage 0–III breast cancer receiving traditional open mastectomy or R-E-NSM with DIBR between May 2020 and April 2022, using propensity score matching to reduce selection bias. Follow-up through December 2023 assessed medium-term survival outcomes and postoperative complications, supporting feasibility of 24-h discharge while maintaining reliable oncologic safety.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Background

Materials and methods

Results

Conclusions

Keywords

Introduction

’Retrospective Cohort Study A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients Jiao Zhou, MDa,b,e , Yanyan Xie, MDa,b , Faqing Liang, MDa,b , Yu Feng, MDd , Huanzuo Yang, MDa,b , Mengxue Qiu, MDa,b , Qing Zhang, MDa,b , Kawun Chung, MDa,b , Hui Dai, MDa,b , Yang Liu, MDc , Peng Liang, MDc , Zhenggui Du, MDa,b,* Background: Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) has been rapidly becoming popular in the last three years. However, there has yet to be an evaluation of its oncologic safety or the feasibility of discharging patients within 24 h. Materials and methods: In this single-centre retrospective cohort study, individuals diagnosed with stage 0–III breast cancer between May 2020 and April 2022 who underwent traditional open mastectomy or R-E-NSM with DIBR were included. Follow-upstarted on the date of surgery and ended in December 2023 . Data, including demographics, tumour characteristics, medium-term oncological outcomes, and postoperative complications, were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias. Results: This study included 1679 patients [median (IQR) age, 50 [44–57) years] . Of these, 344 patients underwent R-E-NSM with DIBR (RE-R group), and 1335 patients underwent traditional open mastectomy (TOM group) . The median [IQR] follow-up time was 30 [24–36] months [29 (23–33) months in the RE-R group and 30([24–36) months in the TOM group] . Regarding before or after PSM, the P value of local recurrence-free survival (LRFS, 0 .910 and 0 .450), regional recurrence-free survival (RRFS, 0 .780 and 0 .620), distant metastasis-free survival (DMFS, 0.061 and 0.130), overall survival (OS, 0.260 and 0.620), disease-free survival (DFS, 0.120 and 0 .330) were not signiﬁcantly different between the RE-R group and the TOM group. The 3y-LRFS and 3y-DFS rates were 99 .0% and 97 . 1% for the RE-R group and 99 .5% and 95 .3% for the TOM group, respectively. The rates of any complications and major complications were not signiﬁcantly different between the RE-R patients who were discharged within 24 h and the RE-R patients who were not discharged within 24 h (P = 0.290, P = 0.665, respectively) or the TOM patients who were discharged within 24 h (P = 0. 133, P = 0. 136, respectively) . Conclusions: R-E-NSM with DIBR is an innovative oncologic surgical procedure that not only improves cosmetic outcomes but also ensures reliable oncologic safety and fewer complications, enabling patients to be safely discharged within 24 h. A long-term prospective multicenter assessment will be supporting. Keywords: breast cancer, direct-to-implant breast reconstruction (DIBR), discharge within 24 hours, oncologic safety outcomes, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) aDepartment of General Surgery, bBreast Center, cDay Surgery Center, West China Hospital, Sichuan University, dDepartment of General Surgery, The Fourth People ’s Hospital of Sichuan Province, Chengdu and eDepartment of Thyroid and Breast Surgery, The First People’s Hospital of Ziyang, Sichuan University, Ziyang, China J.Z., Y.X. and F.L. contributed equally to this work and share the ﬁrst authorship. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article *Corresponding author. Address: Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China, Tel.: +861 388 0768 222; fax: + [862 885 422 953. E-mail: docduzg@163.com](862 885 422 953. E-mail: docduzg@163.com) (Z. Du). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article di

FAQs

What clinical question does this study address?

The study evaluates oncologic safety and whether discharging breast cancer patients within 24 hours is feasible after reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction.

How was the study designed and how were biases handled?

It was a single-centre retrospective cohort study including stage 0–III patients treated between May 2020 and April 2022. Propensity score matching was performed to minimize selection bias.

What were the main findings regarding oncologic outcomes?

Local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival, overall survival, and disease-free survival were not significantly different between the reverse-sequence endoscopic group and the traditional open mastectomy group.

Were there differences in complications for patients discharged within 24 hours?

No significant differences in any or major complications were observed for reverse-sequence endoscopic patients discharged within 24 hours versus those not discharged within 24 hours, and similarly for traditional open mastectomy patients.

Sep 21, 2026

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