Minimally Invasive (Endoscopic) Mastectomy

Single-Port Endoscopic Nipple Sparing Mastectomy

What is this procedure?

Single-port endoscopic nipple sparing mastectomy (E-NSM) is a minimally invasive surgical technique for removing breast tissue through a single small incision of just 3–4 cm, placed along the anterior axillary line at the level of the nipple-areolar complex. Unlike traditional open surgery, all instruments — including a high-definition camera — pass through one specialised port device, preserving the nipple and areola and concealing the scar in the natural crease of the armpit.

This approach is suitable for selected patients undergoing preventive (prophylactic) mastectomy, or those with carefully selected early-stage breast cancer. Your surgeon will advise whether it is appropriate for your individual circumstances.

Key feature: All surgical work is completed through one 3–4 cm incision placed at the anterior axillary line at nipple level — so any resulting scar is both small and discreetly hidden in the armpit.

MINIMALLY INVASIVE APPROACH

The GelPOINT® Mini Access Port

The Applied Medical GelPOINT® Mini is a two-component single-port device that makes this procedure possible:

  • GelSeal® flexible gel cap — sits proud of the skin and accommodates up to three instrument channels (5–12 mm) simultaneously, with two stopcock valves for insufflation and smoke evacuation.

  • Alexis® wound protector/retractor — a 360° atraumatic sleeve lining and protecting the 3–4 cm incision through the tissue wall, allowing instruments to move freely without damaging the skin edges.

STEP BY STEP

How the procedure works

Performed under general anaesthesia, the operation typically takes 2–4 hours. All four steps are completed through the single 3–4 cm axillary incision:

  • Step 1 Anaesthesia

    General anaesthetic administered; patient positioned comfortably.

  • Step 2 Single incision

    One 3–4 cm vertical cut at the anterior axillary line, nipple level.

  • Step 3 Port insertion

    GelPOINT® Mini placed. Camera, instruments and suction pass through one port.

  • Step 4 Tissue removal

    Breast tissue dissected endoscopically and extracted via the 3–4 cm port.

BENEFITS

Benefits compared with traditional mastectomy

The single 3–4 cm port approach offers significant advantages over conventional open surgery:

Traditional mastectomy

Incision size: 15–20 cm large scar

Scarring: Prominent chest scar

Post-op pain: More significant

Hospital stay: 2–3 days

Return to activity: 4–8 weeks

Nipple preservation: Not possible

Wound infection risk: Higher

Immediate reconstruction: Not possible

Single-port E-NSM

Incision size: 3–4 cm, hidden in axilla

Scarring: Minimal, concealed in armpit

Post-op pain: Reduced — less tissue disruption

Hospital stay: 1–2 days

Return to activity: 2–4 weeks

Nipple preservation: Preserved in eligible patients

Wound infection risk: Lower — smaller wound surface

Immediate reconstruction: Usually offered

YOUR RECOVERY

Recovery timeline

  • Day 0 - Surgery

    Operation performed under general anaesthesia.

  • Days 1–2: Discharge Home

    Most patients go home within 1–2 days.

  • Weeks 1–2: Wound Care & Rest

    Wound dressing care; pain managed with standard medications.

  • Weeks 2–3: Light Activities

    Gentle walking and daily tasks resume.

  • Weeks 4–6: Return to Normal Life

    Most patients back to full activity. Follow-up with surgeon.

COMMON QUESTIONS

Frequently Asked Questions

Will I have a visible scar?

You will have one small scar of approximately 3–4 cm placed in the armpit (axilla). Because it sits in the natural skin fold, it is well concealed. Scars typically fade considerably over 12–18 months.

Is tissue removal as complete as with open surgery?

When performed by an experienced endoscopic surgeon, studies show the completeness of breast tissue removal is equivalent to traditional open mastectomy, maintaining full oncologic principles.

Can I have breast reconstruction at the same time?

In many cases, yes. Implant-based or other reconstruction may be performed simultaneously. Your surgeon will outline what is possible for your specific situation.

Why is a single port used instead of multiple incisions?

Concentrating all instruments through one port means only one incision heals, further reducing pain, infection risk, and scarring compared with multi-port approaches.

How long will I be in hospital?

Most patients are discharged within 1–2 days, compared with 3–5 days for traditional open mastectomy.

Who is this procedure suitable for?

E-NSM is ideal for selected patients with small to moderate breast size who meet oncologic criteria. Suitability depends on breast size, tumour characteristics, and overall health. Your surgeon will advise you individually.

Important notice: This information is for patient education purposes only and does not replace personalised medical advice or clinical judgment. Please discuss your specific situation, risks, and surgical options with your treating surgeon before making any decisions about surgery.