ObjectiveTo compare the differences in surgical efficiency, surgical safety, aesthetic outcomes, and oncological safety between axillary single-incision endocsopic breast-conserving surgery (ASIEBS) and conventional open breast-conserving surgery (COBS), and to evaluate the clinical value of ASILBCS based on the “HUAXI hole 3” technique. MethodsA retrospective cohort study was conducted on the clinicopathologic data of patients who underwent breast-conserving surgery for breast cancer at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were assigned into an ASILBCS group and a COBS group based on the surgical approach. Both groups received standardized surgical treatment and postoperative follow-up. The observation indicators included baseline characteristics, intraoperative data, postoperative complications, aesthetic outcome (by Ueda score and Harris score evaluation), and oncological safety (local recurrence and distant metastasis). ResultsA total of 67 patients were enrolled, with 41 in the ASIEBS group and 26 in the COBS group. There was no statistically significant differences in the comparison of other baseline data between the two groups (P>0.05), except for the proportions of patients with diabetes mellitus and those positive for human epidermal growth factor receptor 2 (P＜0.05). The ASIEBS group showed superior aesthetic outcomes compared to the COBS group (Ueda score: P=0.013; Harris score: P=0.047). However, the ASIEBS group had higher median total hospitalization costs (12 779.00 yuan vs. 12 354.50 yuan, Z=–2.16, P=0.03). The median follow-up time was 31.43 months in the ASIEBS group and 21.20 months in the COBS group (Z=–2.36, P=0.02). During follow-up, only one patient with local recurrence occurred in the ASIEBS group, and no distant metastasis or death event was observed in both groups. ConclusionThe ASIEBS based on the “HUAXI hole 3” technique is comparable to COBS in terms of surgical efficiency, surgical safety, and oncological safety, while offering superior aesthetic outcomes.
Objective To evaluate the aesthetic outcomes and safety of titanium-coated polypropylene mesh (TCPM) in immediate implant-based breast reconstruction (IBBR) following single-axillary approach endoscopic nipple-sparing mastectomy (NSM), and to provide references for the clinical application of synthetic meshes. Methods A retrospective analysis was conducted on 173 female patients who underwent immediate IBBR following single-axillary approach endoscopic NSM between May 2020 and June 2024. Patients were divided into a non-mesh group (n=100) and a mesh group (n=73) based on TCPM utilization. Baseline data, including body mass index (BMI), smoking history, alcohol consumption history, diabetes mellitus, hypertension, menstrual status, and postoperative radiotherapy, chemotherapy, and endocrine therapy, showed no significant differences between the two groups (P>0.05), whereas patients in the mesh group were significantly older than those in the non-mesh group (P<0.05). Postoperative complications, capsular contracture (Baker grading), prosthesis texture, aesthetic outcomes (modified Ueda score), and patient satisfaction [evaluated via the Breast Reconstruction Patient-Reported Outcome Scale (BREAST-Q)] were compared between the two groups. Ordinal logistic regression analysis was performed to identify independent factors influencing aesthetic outcomes. Results All patients were successfully followed up postoperatively. The follow-up duration was 30.50 (23.24, 40.04) months in the non-mesh group and 23.95 (18.52, 32.57) months in the mesh group, with no significant difference between the two groups (P>0.05). Regarding complications, no significant difference was observed between the two groups in the incidence of postoperative fever, upper limb lymphedema, seroma, wound dehiscence, operative site hemorrhage, or skin necrosis (P>0.05). However, the non-mesh group demonstrated significantly better outcomes than the mesh group in Baker grading for capsular contracture, implant texture, and aesthetic ratings (P<0.05). According to the postoperative BREAST-Q assessment, the non-mesh group scored higher in satisfaction with the reconstruction outcome and satisfaction with the surgeon (P<0.05). No significant difference was noted between the groups regarding psychosocial well-being, sexual health, breast appearance, implant contour, satisfaction with chest recovery, or satisfaction with the medical team (P>0.05). Univariate ordinal logistic regression analysis revealed that menstrual status, mesh usage, and postoperative radiotherapy, endocrine therapy, upper limb lymphedema were associated with breast aesthetic outcomes (P<0.05). Multivariate ordinal logistic regression analysis further confirmed that postoperative radiotherapy and mesh usage were independent risk factors for diminished aesthetic outcomes (P<0.05). Conclusion In immediate IBBR following single-axillary approach endoscopic NSM, omitting TCPM mesh superior aesthetic outcomes, a more natural breast texture, and a lower incidence of severe capsular contracture without increasing the risk of complications. Therefore, the routine application of TCPM in this specific surgical procedure warrants cautious consideration.