Endoscopic subcutaneous mastectomy is a minimally invasive breast surgery method in which breast tissue is removed through small incisions with the help of an endoscopic camera system. In this method, the breast skin and nipple-areola complex may be preserved in suitable patients while the breast tissue is removed.
Unlike classical mastectomy methods, the incision is usually planned not in a prominent area on the breast, but in a more concealable area near the armpit or on the lateral chest wall. Therefore, endoscopic subcutaneous mastectomy is performed in selected patients who are carefully evaluated in terms of both oncological safety and aesthetic outcomes.
The aim of this surgical approach is not only to remove breast tissue. It also aims to reduce visible incision scars, create a suitable basis for breast reconstruction, and support the patient’s postoperative body perception.
What Is Endoscopic Subcutaneous Mastectomy Performed For?
Endoscopic subcutaneous mastectomy is performed in cases where breast tissue needs to be surgically removed but preservation of the skin structure is possible. In breast cancer surgery, not only controlling the disease but also postoperative appearance, quality of life, and psychological adaptation have become important in recent years.
For this reason, methods such as nipple-sparing mastectomy, skin-sparing mastectomy, endoscopic breast surgery, and robotic breast surgery may be considered in selected patients. The endoscopic approach may contribute to performing the procedure through a small incision and creating a less visible scar on the breast.
In this method, the main priority should always be oncological safety. Although aesthetic expectations are important, removing the tumor with safe margins and preserving treatment success are the main goals of surgical planning.
Who Is Endoscopic Subcutaneous Mastectomy Suitable For?
Endoscopic subcutaneous mastectomy may be considered in patients with early-stage breast cancer who do not have skin involvement. Patients whose nipple can be preserved, whose tumor is located at a safe distance from the nipple, and for whom reconstruction is planned may be suitable candidates for this method.
In people carrying genetic mutations such as BRCA1 or BRCA2, the endoscopic approach may also be considered for preventive mastectomy. In these patients, a more aesthetic reconstruction plan can be made together with the removal of breast tissue.
In some patients diagnosed with ductal carcinoma in situ, endoscopic subcutaneous mastectomy may also be among the options when the extent of spread, breast structure, and surgical margin safety are appropriate.
Conditions That May Be Suitable For Endoscopic Subcutaneous Mastectomy
Early-stage breast cancer, tumors without skin involvement, patients suitable for nipple preservation, people planned for preventive mastectomy due to genetic risk, and patients for whom breast reconstruction is considered may be evaluated for this method.
In Which Patients Is Endoscopic Subcutaneous Mastectomy Not Performed?
Endoscopic subcutaneous mastectomy is generally not a suitable option in advanced-stage breast cancers or breast cancers with skin involvement. Inflammatory breast cancer, spread to the skin, nipple involvement, and large tumor volume may make it difficult to perform this method safely.
In breast tissue that has previously developed severe radiotherapy damage, skin circulation and wound healing may be negatively affected. Therefore, previous treatments should also be taken into account during the surgical decision-making process.
Conditions That May Not Be Suitable For Endoscopic Subcutaneous Mastectomy
Inflammatory breast cancer, skin invasion, nipple involvement, large tumor volume, locally advanced tumor, and severe radiotherapy damage may require different surgical methods.
How Is Endoscopic Subcutaneous Mastectomy Surgery Performed?
Before endoscopic subcutaneous mastectomy surgery, the patient’s breast imaging, biopsy results, tumor location, distance between the tumor and the nipple, and lymph node status are evaluated. Mammography, breast ultrasonography, and breast MRI findings may be reviewed together for surgical planning.
During the surgery, the patient is prepared in the supine position. The incision is usually planned near the armpit or on the lateral chest wall, approximately 3-5 cm in length. Through this incision, the surgical field is visualized with an endoscopic camera.
By carefully dissecting the subcutaneous plane, the breast tissue is separated from the fascia over the pectoral muscle. Bleeding control is achieved with the help of energy devices. After the breast tissue is removed, reconstruction with an implant, tissue expander, or the patient’s own tissue may be performed in the same session.
What Stages Are Included In The Endoscopic Subcutaneous Mastectomy Surgery Process?
The surgery process generally consists of preoperative evaluation, incision planning, endoscopic visualization, removal of breast tissue, bleeding control, reconstruction, and postoperative follow-up stages. Each stage is planned individually according to the patient’s tumor characteristics and general health condition.
What Are The Advantages Of Endoscopic Subcutaneous Mastectomy?
The main advantage of endoscopic subcutaneous mastectomy is that the incision can be planned in a more concealable area. This may reduce the appearance of a visible scar on the breast and ease the patient’s postoperative concerns about appearance.
The minimally invasive approach may provide less tissue trauma, more controlled bleeding management, and a more comfortable recovery process in some patients. Preserving the breast skin may contribute to achieving a more natural appearance, especially in patients who will undergo reconstruction with an implant or tissue.
In patients whose nipple-areola complex can be preserved, body perception and psychological adaptation may be affected more positively. Therefore, endoscopic subcutaneous mastectomy should be evaluated not only as a surgical technique but also in terms of quality of life.
Prominent Benefits Of The Endoscopic Approach
Less visible incision scarring, preservation of the breast skin, support for reconstruction results, minimally invasive surgical approach, and postoperative aesthetic harmony are among the prominent benefits of this method.
