{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T04:17:24Z","timestamp":1793247444865,"version":"4.5.0"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec id=\"ab-soi240056-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240056-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the differences in postoperative complications between C-NSM and M-NSM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240056-6\">\n                    <jats:title>Design, Setting, Participants<\/jats:title>\n                    <jats:p>This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240056-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>M-NSM or C-NSM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240056-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240056-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (&amp;amp;lt;30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.53; &amp;amp;lt;90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.004 and OR, 8.78; 95% CI, 1.88-41.02;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240056-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.2977","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T11:01:41Z","timestamp":1723633301000},"page":"1177","source":"Crossref","is-referenced-by-count":47,"title":["Minimal Access vs Conventional Nipple-Sparing Mastectomy"],"prefix":"10.1001","volume":"159","author":[{"given":"Joo Heung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai Min","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soong June","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beom Seok","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 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Yoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Korea University Ansan Hospital, Ansan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Eun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Konkuk University School of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zisun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Joon","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Incheon St. Mary\u2019s Hospital, The Catholic University of Korea, Incheon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moo Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Keimyung University School of Medicine, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunhwa","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuk Jai","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kyoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chung-Ang University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Jun","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Uk","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Konyang University Hospital, Daejeon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nak-Hoon","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Statistics, Keimyung University, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Seok","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeeyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Korea Robot-endoscopy Minimal Access Breast Surgery Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeea","family":"Lee","sequence":"additional","affiliation":[{"name":"for the Korea Robot-endoscopy Minimal Access Breast Surgery Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sae Byul","family":"Lee","sequence":"additional","affiliation":[{"name":"for the Korea Robot-endoscopy Minimal Access Breast Surgery Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Woo","family":"Chang","sequence":"additional","affiliation":[{"name":"for the Korea Robot-endoscopy Minimal Access Breast Surgery Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee 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