[Objective]
Among various available options for breast reconstruction, endoscopy guided nipple-preserving skin-sparing mastectomy with immediate silicone gel implant reconstruction has become the preferred option attributing to its superior aesthetic outcome. In addition, to achieve better symmetry and overall satisfaction, contralateral breast augmentation is usually required to correct its smaller size and ptotic appearance.
[Material and Methods]
Here we present a case of a 42-year-old female diagnosed with right side breast cancer, luminal B, (ER95, PR95, HER2-, Ki67 25%), size 1.2 cm, located 1 cm away from the nipple. The operation was preceded with nipple sparing mastectomy and sentinel lymph node biopsy through axillary incision under endoscopic guidance. Due to the lesion’s proximity with the nipple, an additional periareolar incision was required for tissue biopsy. After removing 225grams of breast tissue, a silicone gel implant, Mentor Textured round 325ml, was immediately inserted beneath the PM (pectoralis major) and SA (serratus anterior) muscles. The contralateral breast was also augmented by the implant, Mentor Textured round 150ml, at the same time with dual plane design.
[Results]
The patient recovered smoothly and the drainage was removed one week after, and she rated the breast aesthetics as excellent with a score of 9 out of 10. No further chemotherapy or radiotherapy was required due to stage I breast cancer with margin-free tumor resection (total mastectomy). The patient was only required to receive hormone therapy after the operation; therefore, she was greatly satisfied with her overall quality of life with minimal disturbance to her ordinary life, and would highly recommend our treatment protocol to other patients as per Breast-Q questionnaire.

[Conclusions]
Nipple-preserving skin-sparing mastectomy with immediate implant reconstruction, combined with contralateral symmetric augmentation, is an optimal choice for oriental women of small to moderate breast size who require surgical treatment after breast cancer diagnosis.