Comparison of Postoperative Complications and Perioperative Outcomes Between Endoscopic-Assisted and Open Prosthetic Breast Reconstruction: A Retrospective Study

Abstract

AIM: To compare the incidence of complications within 90 days postoperatively and perioperative outcomes between endoscopic-assisted and open prosthetic breast reconstruction.METHODS: Data from female patients who underwent total mastectomy and prosthetic breast reconstruction from January 2021 to December 2025 were retrospectively collected. A total of 213 patients were included. Patients were divided into an endoscopic-assisted group (endoscopic group) and an open group according to the surgical approach. Propensity score matching (PSM) was performed at a 1:1 ratio to balance baseline covariates. After PSM, 61 patients were in each group, with balanced baseline characteristics. Intraoperative parameters (operative time, blood loss), postoperative recovery indices (postoperative day 1 drainage volume, drainage duration, length of hospital stay, pain visual analogue scale (VAS) score), patient-reported outcomes (BREAST-Q breast satisfaction, aesthetic score), and complications within 90 days postoperatively were compared between the two groups. Depending on normality test results, continuous variables were analyzed using the t-test or Mann-Whitney U test, and categorical variables using the χ2 test or Fisher’s exact test.RESULTS: The endoscopic group had longer implant placement time (p < 0.001) and total operative time (p < 0.001) than the open group, but less intraoperative blood loss (p < 0.001). The endoscopic group showed significantly better outcomes in terms of drainage volume on postoperative day 1, drainage duration, hospital stay, and VAS scores on postoperative days 1 and 3 (all p < 0.05). BREAST-Q breast satisfaction (p = 0.004), aesthetic score (p = 0.005), and good or excellent rate (p = 0.028) were higher in the endoscopic group than in the open group. No significant differences were found between the two groups in overall complication rate or any individual complication (all p > 0.05).CONCLUSIONS: After balancing confounders with PSM, endoscopic-assisted prosthetic breast reconstruction was associated with longer operative time than the open approach, but it was associated with lower intraoperative blood loss, faster postoperative recovery, less early pain, and higher patient satisfaction and aesthetic scores, with no significant differences observed in 90-day complications between the two groups. The endoscopic-assisted technique showed favorable perioperative outcomes in this cohort, especially suitable for patients with high demands for rapid rehabilitation and aesthetic results.