To evaluate the clinical efficacy, oncologic safety, and aesthetic outcomes of axillary single-port endoscopic subcutaneous glandular resection combined with immediate implant reconstruction in patients with breast cancer, and to provide evidence for optimizing surgical approach selection.

This retrospective comparative study included 129 female breast cancer patients who underwent subcutaneous glandular resection with immediate implant-based reconstruction at the 960th Hospital of the Joint Logistics Support Force from Jan. 2023 to May 2025. Patients were allocated to an endoscopic group (n=67) or an open surgery group (n=62) according to surgical approach. Baseline characteristics, perioperative parameters, postoperative complications, oncologic outcomes, and aesthetic satisfaction were systematically compared between groups.

No significant differences were found between the two groups in baseline characteristics, including age, body mass index, smoking history, diabetes, tumor T/N stage, ER/PR/HER2 status, and perioperative treatments (all P>0.05). Intraoperative blood loss was significantly lower in the endoscopic group than in the open group (40.9±27.6 ml vs. 71.5±66.3 ml, P=0.001). The overall postoperative complication rates were 11.3% and 7.5% in the open and endoscopic groups, respectively, with no significant difference (P=0.550). The incidence of nipple-areolar complex (NAC) ischemia/necrosis was 3.2% versus 4.5%, also without a significant difference (P>0.05). Aesthetic evaluation showed higher BREAST-Q scores in the endoscopic group at 1 month and 3 months postoperatively (67.96±5.33 vs. 64.11±6.38, P=0.019; 76.19±4.47 vs. 67.46±6.41, P<0.001). The proportion of "excellent" Harris ratings was also higher in the endoscopic group (79.1% vs. 61.3%, P=0.034). During follow-up, one case of nipple Paget′s disease recurrence occurred in the endoscopic group, whereas no local recurrence was observed in the open group; no distant metastasis or death occurred in either group, and the between-group differences were not statistically significant.

Endoscopic nipple-sparing mastectomy with immediate implant reconstruction achieves comparable short-term oncologic safety and surgical efficacy to open surgery while reducing intraoperative trauma and significantly improving early aesthetic outcomes and patient satisfaction. Longer follow-up is warranted to confirm long-term efficacy and safety.