Endoscopic Nipple-Sparing Mastectomy

What Is Endoscopic Nipple-Sparing Mastectomy?

Endoscopic nipple-sparing mastectomy (E-NSM) is an advanced, minimally invasive approach to mastectomy in which the breast tissue is removed while preserving the breast skin and nipple-areolar complex. We perform it through a single small incision hidden within the lateral inframammary fold, where the breast meets the chest wall, using a camera and specialised instruments for a magnified view. The aim is to combine safe mastectomy with preservation of the natural breast envelope and a discreetly positioned scar.

How Is This Technique Different?

Conventional nipple-sparing mastectomy generally needs a longer incision to access the breast. A modification we've developed has also helped reduce operative time — historically one of the technique's main drawbacks — and we've extended the indications beyond small-to-medium breasts to suit a wider range of patients.

Why Is the Incision Hidden in the Breast Fold?

Rather than the axilla (armpit) — a site that can remain visible in singlets and swimwear — we place the incision within the lateral inframammary fold, a natural crease that keeps the scar far less conspicuous. This also means much of the breast skin stays supported by surrounding tissue during surgery, which may help preserve blood supply and nerve pathways to the nipple-areolar complex. Normal sensation can't be guaranteed, but preserving it is an important consideration in how the operation is performed.

Who May Be Suitable?

Selected patients undergoing risk-reducing mastectomy — including BRCA1, BRCA2 or other high-risk mutation carriers — as well as appropriately selected breast cancer patients. Suitability depends on factors including breast size and shape, the location of any cancer relative to the nipple, previous surgery or radiotherapy, and planned reconstruction. Cancer safety always comes first.

The Operation and Immediate Reconstruction

Performed under general anaesthesia, the breast tissue is removed through the same small incision while preserving the skin and, when oncologically safe, the nipple-areolar complex. A sentinel lymph node biopsy can be performed at the same time if needed, and immediate breast reconstruction — direct-to-implant or via a tissue expander — is commonly done in the same operation.

Recovery and Risks

Most patients have a short hospital stay, temporary drains, and a gradual return to normal activities over the following weeks. As with any mastectomy, this remains major breast surgery with real risks, including bleeding, infection, delayed healing, and reduced or altered nipple sensation. 

Is Endoscopic Mastectomy Less Extensive Than Conventional Mastectomy?

The incision is smaller, but the mastectomy itself is not — the same breast tissue is removed either way. The difference is purely in how it's accessed.

Read the complete guide to this procedure — including the full step-by-step operation details, recovery timeline and risk list — at  Breast & Wellness Centre.

If you'd like to discuss whether this approach may be suitable for you, book a consultation.

Medically reviewed by A/Prof Farid Meybodi. Last reviewed: 16 September 2026.