FEMH Magazine

  • 2022-07-25

3D Endoscopic Nipple Sparing Total Mastectomy

General Surgery Loi, Chao-Man


      According to the data of the Ministry of Health and Welfare, breast cancer is the most common cancer among women in our country. More than 10,000 women suffer from breast cancer every year, and the incidence is between 45 and 64 years old. Breast cancer is the 4th cause of cancer death of Taiwan female. Therefore, early diagnosis and early treatmentwill be an important topic for breast cancer.

      The treatment of breast cancer and carcinoma in situ is mainly based on surgical resection. Today, total mastectomy and breast-conserving surgery are the two main surgical methods of breast cancer operation. Breasts are an important feature of women. In the past, breast cancer surgery would remove the entire breast and nipple areolar complex, which greatly affected the body appearance (Figure 1), and often caused great psychological trauma to the patient. In addition, breast-conserving surgery also requires making a wound on the breast skin and performing a wide excision of the tumor. Even if the breast is preserved, the shape of the breast will be changed after the operation. Therefore, surgeon developed new operation method that can hide the wound, such as endoscopic mastectomy and Da Vinci robotic arm mastectomy.


Figure 1. The wound of traditional total mastectomy

What is 3D Endoscopic Nipple Sparing Total Mastectomy?

       Endoscopic surgery has been developed in the field of surgery for a long time, especially of breast surgery. 3D endoscopic breast cancer surgery only requires a 4-6 cm wound to perform a single-port endoscopic operation.During the operation, we will sent the specimen of nipple margin for Frozen section examination. If the pathology report showed that the nipple was not invaded by cancer cells, we can performednipple and skin sparing total mastectomy.The wound is hidden under the lateral side of the chest wall(Figure 2), so there is no wound was found on the breast.Then the breast tissue is completely removed from the lateral wound, and immediate breast reconstruction is performed by plastic surgeon.


Figure 2. The wound of endoscopic total mastectomy

      The 3D endoscopic imaging can allows doctors to have a clear image of the three-dimensional structure of the breast (including the depth of field, blood vessels, breast tissue, and skin) during the operation (Figure 3), which greatly improves the safety of the operation and the accuracy of tumor resection.


Figure 3. The Anatomy of breast during endoscopic operation.

The difference between breast cancer operation:




1.Breast conserving surgery

l Small wound

l Preserve the sensation of breast

l No need for breast reconstruction

l Received radiotherapy

l If the margin of the specimen showed cancer cell, it must be received second time of operation

l Only can used in early breast cancer

2.Simple mastectomy

l No need for radiotherapy

l Big wound, big change of body appearance

l Numbness sensation of breast after operation

l Remove the nipple areolar complex

3.Endoscopic nipple sparing total mastectomy

l Small wound, can hide under lateral chest wall

l No need for radiotherapy

l Cost of breast reconstruction

l Longer operation time

l Only can used in early breast cancer


Indication of 3D Endoscopic Nipple Sparing Total Mastectomy

1. Ductal carcinoma is situ

2. Stage I and II breast cancer

3. Multicentric breast cancer

4. Prophylactic mastectomy


Contraindication of 3D Endoscopic Nipple Sparing Total Mastectomy

1. Big size of breast (Above E cup)

2. The tumor location near the nipple

3. Inflammatory breast cancer

4. Tumor invaded the skin or muscle layer



The advantages of endoscopic breast cancer surgery is that the wound can be hidden, which is similar to the breast augmentation surgery. In cancer surgery, endoscopic surgery of breast may be easier of tumor recurrence? The answer is not. Breast cancer endoscopic surgery has been developed for about 20 years and the oncological result has been followed more than ten years. The recurrence rate of traditional surgery and endoscopic surgery is the same. The difference is only the size of the wound, the location of the wound and the body appearance.

When you get breast cancer, don’t be afraid to find doctor. Breast cancer therapy includes surgery, chemotherapy, targeted therapy, radiation therapy, immunotherapy, have very good result. Just discuss with your doctor and choose the most suitable one for you.