{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:51:41Z","timestamp":1791496301657,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In recent years, endoscopic\u2010assisted techniques have seen accelerated adoption in breast surgery, particularly in the context of mastectomy and subsequent reconstruction procedures. Due to the higher surgical difficulty and longer operation time, it is still not the mainstream of breast surgery. We aimed to evaluate the learning curve of transaxillary endoscopy\u2010assisted nipple\u2010sparing mastectomy (E\u2010NSM) combined with immediate prepectoral implant\u2010based breast reconstruction (IBBR), and the specifics of this technique were elaborated in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From May 2022 to August 2024, patients who underwent transaxillary E\u2010NSM with immediate prepectoral IBBR by the same surgeon at our hospital were enrolled in this study. Operative time trends were assessed using cumulative sum (CUSUM) analysis to characterize the learning curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      43 procedures performed on 40 patients were included in our analysis. Based on CUSUM analysis, the learning curve of the operative time began to decline consistently after 17 procedures. The operation time decreased significantly from 244.5\u2009\u00b1\u20099.4\u2009min in learning phase to 153.4\u2009\u00b1\u200938.4\u2009min in mature phase (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;\u20090.001). one (2.5%) patient had partial nipple ischemia, two (5.0%) had skin blister formation, one (2.5%) patient had skin flap necrosis. 6 (15.0%) patients had seroma needing aspiration. During the 24\u2010month median follow\u2010up, neither implant loss nor local recurrence was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Transaxillary E\u2010NSM with immediate prepectoral IBBR is a safe and effective technique. About 17 procedures are needed to reach the proficient level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70537","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:00:38Z","timestamp":1771567238000},"page":"1197-1204","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Learning Curve of Transaxillary Endoscopy\u2010Assisted Nipple\u2010Sparing Mastectomy With Immediate Prepectoral Implant\u2010Based Breast Reconstruction"],"prefix":"10.1111","volume":"96","author":[{"given":"Zhen\u2010qiang","family":"Lian","sequence":"first","affiliation":[{"name":"Breast Disease Center Guangdong Women and Children Hospital  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang\u2010yang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Breast Disease Center Guangdong Women and Children Hospital  Guangzhou Guangdong 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