虽然过去仅使用开放式方法进行乳腺癌保留乳头乳房切除术（NSM），但使用内窥镜和机器人手术器械的频率正在迅速增加。然而，关于术后并发症以及微创 NSM (M-NSM) 与传统 NSM (C-NSM) 相比的优缺点的研究有限。旨在探讨 C-NSM 和 M-NSM 术后并发症的差异。是一项回顾性多中心队列研究，招募了 1583 名 19 岁及以上乳腺癌女性患者，她们于 2018 年 1 月至 2020 年 12 月期间在韩国 21 所大学医院接受了 NSM。排除 NAC 中的病理恶性肿瘤、炎性乳腺癌、浸润胸壁或皮肤的乳腺癌、转移性乳腺癌或医疗记录不足。分析2021年11月至2024年3月的数据。M-NSM或C-NSM。评估手术3个月内的临床病理因素和术后并发症。使用包括逻辑回归在内的统计分析来确定与并发症相关的因素。有 1356 名患者（平均 [SD] 年龄，45.47 [8.56] 岁）接受了 C-NSM，227 名患者（平均 [SD] 年龄，45.41 [7.99] 岁）接受了 C-NSM 治疗。 ] 年）接受 M-NSM（35 次内窥镜辅助，192 次机器人辅助）。两组之间的短期和长期术后并发症没有显着差异（<30天：C-NSM，1356例中的465例[34.29%] vs M-NSM，227例中的73例[32.16%]；P = 。 53；<90 天：C-NSM，1356 中的 525 [38.72%] vs M-NSM，227 中的 73 [32.16%]；P = .06）。从长远来看，C-NSM 术后乳头乳晕复合体坏死比 M-NSM 更常见（C-NSM，1356 例中有 91 例 [6.71%]，而 M-NSM，227 例中有 5 例 [2.20%]；P = .04） 。 M-NSM 后伤口感染发生频率更高（C-NSM，1356 例中有 58 例 [4.28%]，而 M-NSM，227 例中有 18 例 [7.93%]；P = .03）。 C-NSM 术后血清肿发生率更高（C-NSM，1356 例中有 193 例 [14.23%]，而 M-NSM，227 例中有 21 例 [9.25%]；P = .04）。轻度或重度乳房下垂是乳头或乳晕坏死的重要危险因素（比值比 [OR]，4.75；95% CI，1.66-13.60；P = .004 和 OR，8.78；95% CI，1.88-41.02；P = .006，分别）。相反，使用腋中切口、腋前切口或腋窝切口与较低的坏死风险相关（其他切口的 OR，32.72；95% CI，2.11-508.36；P = .01）。与其他乳房重建相比，直接种植体乳房重建中坏死发生率明显较低（OR，2.85；95% CI，1.11-7.34；P = .03）。C-NSM 和 M-NSM 之间相似的并发症发生率表明这两种方法同样安全，可以根据患者的喜好和具体需求进行选择。

While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM).To examine the differences in postoperative complications between C-NSM and M-NSM.This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024.M-NSM or C-NSM.Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications.There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03).The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.