Background: We have applied endoscopic breast surgery (EBS) to several types of breast procedures. Breast-conserving surgery and skin-sparing total mastectomy are considered suitable indications for EBS, which has been performed in more than 700 patients since 2000. EBS allows all surgical procedures to be performed through a small axillary or periareolar skin incision, leaving no visible scar on the breast skin and providing favorable aesthetic outcomes. The most appropriate treatment was selected based on tumor size, location, histological type, stage, patient age, and complications. Our goal was to provide personalized breast cancer treatment that improves clinical outcomes and postoperative quality of life.

Methods: The trans-axillary retromammary approach (TARM) is a single-port procedure performed through a 3-cm axillary skin incision. Under endoscopic guidance through the axillary port, the tissue behind the mammary gland was dissected along the pectoralis major fascia. Fluorescence enhancement was used to localize the tumor, and the mammary gland was resected with a clear surgical margin. The defect was shaped with barbed sutures and filled with resorbable fiber or surrounding tissue to preserve breast contour. Total mastectomy can be performed using the same technique, extended to the entire breast with nipple preservation.

Results: EBS was performed in 780 patients, including breast-conserving surgery in 700 patients and total mastectomy in 80 patients. No serious postoperative complications were observed. The original breast shape was well preserved. The EBS technique was selected according to tumor location and size, patient age, and complications to support personalized treatment. Postoperative aesthetic outcomes were excellent. All patients reported high satisfaction, even 20 years after surgery.

Conclusions: Endoscopic plastic techniques are essential for improving the aesthetic outcomes of EBS. EBS may be considered an optimal surgical approach for breast cancer treatment, offering both oncological curability and favorable cosmetic results.

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