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已发表论文
反向序贯内镜下保留乳头乳晕的乳房切除术联合即刻胸肌后假体植入重建的学习曲线：累积和分析
Authors Zhao R, He C, Jiang W , Lin S , Zhao Y
Received 21 August 2025
Accepted for publication 4 November 2025
Published 8 November 2025 Volume 2025:17 Pages 1041—1050
DOI https://doi.org/10.2147/BCTT.S558984
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Pranela Rameshwar
Renyang Zhao, Chenyang He, Wei Jiang, Shuai Lin, Yang Zhao
The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
Correspondence: Yang Zhao, The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China, Email szhaoy@xjtu.edu.cn
Background: The reverse-sequence endoscopic nipple-sparing mastectomy with immediate prepectoral implant reconstruction (RSEM-IPI) has been described as a safe and feasible procedure for early-stage breast cancer. The aim of this study was to evaluate the learning curve for RSEM-IPI.
Methods: Between January 2023 and February 2024, we collected data on 104 consecutive patients who underwent RSEM-IPI at our hospital (53 for group 1 and 51 for group 2). The surgeons in group 1 completed the endoscopic training and assistance, whereas the surgeons in group 2 did not. The learning curve was analyzed using the cumulative sum (CUSUM) method to assess changes in the operative times across the case sequence.
Results: Among the 281 patients who received breast reconstruction surgeries, a total of 104 consecutive data were recorded and eligible. Both groups had higher rates of postoperative complications including bleeding, nipple-areolar complex (NAC) ischemia, skin ischemia, infection and longer drainage duration during the phrase 1 compared to the phrase 2. Notably, in terms of the most severe postoperative complications, implant expose and loss, both groups exhibited higher rates during the phrase 1. Breast-Q scores for group 1 in phases 1 and 2 were 66 and 84, respectively, while for group 2, they were 67 and 80. As compared with surgeons in group 2, well-trained surgeons in group 1 were more accessible for stable learning curve with fewer training patients (18 patients) and relatively lower rate of postoperative complications (p > 0.05).
Conclusion: The estimated learning curve for RSEM-IPI was achieved after 18 cases in the well-trained surgeon group. The endoscopic training and assistance were critical to master the breast endoscopic surgeries for breast surgeons.
Keywords: breast cancer reconstruction, learning curve, reverse-sequence, endoscopic mastectomy
The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
Correspondence: Yang Zhao, The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China, Email szhaoy@xjtu.edu.cn
Background: The reverse-sequence endoscopic nipple-sparing mastectomy with immediate prepectoral implant reconstruction (RSEM-IPI) has been described as a safe and feasible procedure for early-stage breast cancer. The aim of this study was to evaluate the learning curve for RSEM-IPI.
Methods: Between January 2023 and February 2024, we collected data on 104 consecutive patients who underwent RSEM-IPI at our hospital (53 for group 1 and 51 for group 2). The surgeons in group 1 completed the endoscopic training and assistance, whereas the surgeons in group 2 did not. The learning curve was analyzed using the cumulative sum (CUSUM) method to assess changes in the operative times across the case sequence.
Results: Among the 281 patients who received breast reconstruction surgeries, a total of 104 consecutive data were recorded and eligible. Both groups had higher rates of postoperative complications including bleeding, nipple-areolar complex (NAC) ischemia, skin ischemia, infection and longer drainage duration during the phrase 1 compared to the phrase 2. Notably, in terms of the most severe postoperative complications, implant expose and loss, both groups exhibited higher rates during the phrase 1. Breast-Q scores for group 1 in phases 1 and 2 were 66 and 84, respectively, while for group 2, they were 67 and 80. As compared with surgeons in group 2, well-trained surgeons in group 1 were more accessible for stable learning curve with fewer training patients (18 patients) and relatively lower rate of postoperative complications (p > 0.05).
Conclusion: The estimated learning curve for RSEM-IPI was achieved after 18 cases in the well-trained surgeon group. The endoscopic training and assistance were critical to master the breast endoscopic surgeries for breast surgeons.
Keywords: breast cancer reconstruction, learning curve, reverse-sequence, endoscopic mastectomy