Pioneering Endoscopic Nipple/Skin Sparing Mastectomy in Egypt: Initial Experience after Worldwide Adoption with a Novel Free Dermal Fat Graft Whole Breast Reconstruction

A 45-year-old female presented with a suspicious mass in the upper outer quadrant of the breast, accompanied by adjacent satellite lesions and additional multicentric foci in other quadrants. Core needle biopsy confirmed invasive ductal carcinoma (IDC), Grade II. Although the patient was initially scheduled for a modified radical mastectomy at another institution, she declined a mutilating procedure upon presentation to our center. In accordance with the de-escalation paradigm in breast cancer management, we elected to perform an endoscopic nipple/skin-sparing mastectomy with immediate breast reconstruction.

The surgical technique employed a single-port, pure insufflation approach via a 3 cm incision on the lateral aspect of the breast. Dissection was initiated in the retromammary space, followed by the premammary plane following infiltration with tumescent solution. Preliminary dissection using Hegar’s dilators created multiple juxta-tunnels in a Swiss-cheese pattern, facilitating subsequent dissection with energy-based device. The circummammary ligament was then circumferentially divided, enabling extrapolation of the entire gland. Reconstruction was achieved using a free dermal fat graft harvested from the suprapubic region along the bikini line, representing a novel approach to whole-breast reconstruction. The procedure yielded satisfactory aesthetic outcomes, with near-normal breast consistency, preserved sensation, and appropriate ptosis.

Our first initial experience in Egypt.