Feasibility of modified radical mastectomy with nipple-areola preservation combined with stage I prosthesis implantation using air cavity-free suspension hook in patients with breast cancer

Background Mastoscopic surgery is proven to have lower incidence of postoperative complications and better postoperative recovery than traditional breast cancer surgery. This study aimed to examine the feasibility of mastoscopic modified radical mastectomy (MRM) with skin nipple-areola preservation under air cavity-free suspension hook and stage I silicone prosthesis implantation (SMALND) compared with routine MRM. Methods This was a retrospective study of patients who underwent MRM for breast cancer at the Shengjing Hospital Affiliated to China Medical University between January 1, 2019, and June 30, 2019. Surgical outcomes, complications, satisfaction, and quality of life (Functional Assessment of Cancer Therapy-Breast [FACT-B] [Chinese version]) were compared between the two groups. Results A total of 87 patients were enrolled, with 30 underwent SMALND and 57 underwent routine MRM. The intraoperative blood loss in the SMALND group was lower than in the control group (165.3 +/- 44.1 vs. 201.4 +/- 52.7 ml, P=0.001), the operation time was longer (220.5 +/- 23.9 vs. 155.6 +/- 9.2 min, P<0.001), daily axillary drainage volume was smaller (20.2 +/- 3.6 vs. 24.1 +/- 3.0 ml, P<0.001), daily subcutaneous drainage volume was smaller (15.5 +/- 2.3 vs. 19.3 +/- 3.5 ml, P<0.001), the discharge time was shorter (7.5 +/- 1.6 vs. 9.0 +/- 1.8 days, P<0.001), and FACT-B scores were higher (83.8 +/- 5.6 vs. 72.1 +/- 4.6, P<0.001). The overall satisfaction was higher in the SMALND group than in the controls (76.7% vs. 54.4%, P=0.041). Compared with the controls, the occurrence rates of nipple and flap necrosis, upper limb edema, and paraesthesia in the SMALND group were lower within 6 months (all P<0.05). Conclusions Compared with traditional MRM, SMALND had better surgical outcomes, higher satisfaction, higher quality of life, and lower complication rates.