Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Techniques
3 items
Endoscopic Approaches2 items
Endoscopic nipple-sparing mastectomy: minimally invasive breast cancer surgery
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Paula Escobar, MD, a Breast Surgical Oncologist at Cleveland Clinic, joins the Cancer Advances podcast to provide an inside look into endoscopic nipple-sparing mastectomy.
podcast14:11 · Jul 2026
Case Study: Endoscopic Nipple-Sparing Bilateral Mastectomy Improves Outcomes
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Innovative procedure reduces scarring, recovery time and nipple sensation
article · Jul 2026
Breast-Conserving Surgery1 item
Breast Conserving Therapy Versus Mastectomy: Outcomes Across Different Clinical Characteristics
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Current Breast Cancer Reports - Breast-conserving therapy (BCT) with radiotherapy and mastectomy have long been considered equivalent for early-stage breast cancer based on landmark trials...
article · Jul 2026
Clinical Decision-Making
3 items
Treatment Planning2 items
Impact of Second Opinions on Time to Treatment of Breast Cancer
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Annals of Surgical Oncology - The Commission on Cancer (CoC) advocates that upfront breast surgery is performed within 60 days of diagnosis of stage I–III breast cancer, but it is...
article · Jul 2026
Impact of Second Opinions on Time to Treatment of Breast Cancer
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Obtaining a second opinion increased the overall time from diagnosis to treatment but remained within the CoC standard. There was no difference in TCT between EDP and IDP once initiating care at our institution. Patients should not be disco
article · Jul 2026
Triple-Negative Breast Cancer1 item
Real-World Outcomes with the KEYNOTE-522 Regimen in Early-Stage Triple-Negative Breast Cancer
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Annals of Surgical Oncology - This study aimed to determine if the neoadjuvant (NAT) KEYNOTE-522 regimen was associated with higher rates of pathologic complete response (pCR), corresponding to...
article · Jul 2026
About the Surgeon
2 items
Breast Surgical Oncologist Paula Escobar, MD (Spanish)
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To learn more about Cleveland Clinic’s Dr. Escobar, please visit https://cle.clinic/4gel6Xk
Dr. Escobar specializes in surgery for breast cancer and other breast disorders. Her video is also available in English - https://youtu.be/U31RaQv8
video2:36 · Jul 2026
Breast Surgical Oncologist Paula Escobar, MD
Watch →
To learn more about Cleveland Clinic’s Dr. Escobar, please visit https://cle.clinic/4gel6Xk
Dr. Escobar specializes in surgery for breast cancer and other breast disorders. Her video is also available in Spanish - https://youtu.be/noYd269C
video1:58 · Jul 2026
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Endoscopic nipple-sparing mastectomy: minimally invasive breast cancer surgery
1999 was the first nipple-sparing mastectomy reported.
clinicalPaula Escobar1:26 ↗
Dr. Crowe at Cleveland Clinic was one of the pioneers who developed the open/conventional nipple-sparing mastectomy technique.
clinicalPaula Escobar1:32 ↗
Endoscopic nipple-sparing mastectomy uses the same technique as conventional nipple-sparing mastectomy but with different tools (minimally invasive approach with less scarring).
clinicalPaula Escobar1:53 ↗
The incision is placed in the mid-axillary line hidden by the arm or in the submammary fold, making it completely invisible.
clinicalPaula Escobar2:35 ↗
The procedure involves inflating/expanding the breast with CO2, then introducing laparoscopic instruments through a single incision to remove breast tissue while preserving the envelope.
clinicalPaula Escobar2:49 ↗
Immediate breast reconstruction is attempted at the time of mastectomy, with plastic surgeons adjusting their technique to work through the smaller incision.
clinicalPaula Escobar3:28 ↗
The current endoscopic technique has approximately 5 years of history in its present form.
clinicalPaula Escobar4:07 ↗
Minimally invasive breast surgery started in Asian countries approximately 20 years ago using mechanical arms to lift the breast, but early attempts had complications in skin flaps and nipples due to limited technology.
clinicalPaula Escobar4:10 ↗
The technique developed in Europe (France, Spain, Italy) using CO2 insufflation and is now being learned in the US.
clinicalPaula Escobar4:35 ↗
Very few surgeons in the US currently perform endoscopic nipple-sparing mastectomy, making it difficult for patients to access.
epidemiologicalPaula Escobar5:10 ↗
Three hands-on simulated model courses have been held in the US to train surgeons in the technique.
clinicalPaula Escobar5:23 ↗
Cleveland Clinic has trained multiple surgeons in the endoscopic technique, with Dr. Escobar helping to train colleagues.
clinicalPaula Escobar5:47 ↗
Robotic breast surgery takes a long time, requires a robot, has a long learning curve, and is not FDA approved (currently only available in trials at limited US centers).
clinicalPaula Escobar6:16 ↗
Endoscopic surgery uses instruments already available for abdominal/hernia surgery, requiring no special equipment purchases.
clinicalPaula Escobar6:36 ↗
Operating time for endoscopic surgery, when experienced, is similar to open/conventional surgery.
clinicalPaula Escobar7:04 ↗
Indications for endoscopic nipple-sparing mastectomy are very similar to conventional nipple-sparing mastectomy.
clinicalPaula Escobar7:40 ↗
Patients are not good candidates if tumor involves the skin, is very close to the muscle, is very close to the nipple, or involves the skin.
clinicalPaula Escobar7:46 ↗
Best candidates have cup A, B, or C breasts (not larger breasts at current learning curve stage).
clinicalPaula Escobar8:45 ↗
Procedure is performed on patients with no ptosis or ptosis grade 1 or 2, as higher grades result in poor cosmetic outcomes.
clinicalPaula Escobar8:59 ↗
Patient advantages include superior cosmetic outcome, hidden/invisible scar, and likely quicker recovery with less pain (similar to laparoscopic vs open abdominal surgery).
clinicalPaula Escobar9:26 ↗
Preliminary studies suggest patients have better sensation in the nipple and mastectomy skin flap, though quality trials are needed.
clinicalPaula Escobar9:51 ↗
Initial patients have been very happy with the procedure and recovered very quickly.
clinicalPaula Escobar10:09 ↗
Oncological safety of conventional nipple-sparing mastectomy has been proven by data.
clinicalPaula Escobar10:26 ↗
Endoscopic technique may be better than conventional because the magnified screen visualization allows better handling of the mastectomy skin flap and improved visualization of breast tissue behind the nipple and axillary tail.
opinionPaula Escobar10:41 ↗
No insurance coverage problems have occurred; procedure is coded as skin-sparing mastectomy since no specific code exists yet.
clinicalPaula Escobar11:34 ↗
Cleveland Clinic has performed endoscopic nipple-sparing mastectomy with endoscopically-assisted sentinel node retrieval through a single incision.
clinicalPaula Escobar11:56 ↗
Future applications include axillary dissection and lumpectomy for tumors in inner portions of the breast (scar in axilla instead of breast).
clinicalPaula Escobar12:12 ↗
The technique has been used for gynecomastia surgery in one male patient.
clinicalPaula Escobar12:24 ↗
Dr. Escobar predicts widespread adoption will occur similar to laparoscopic cholecystectomy, driven by patient experience, outcomes, and faster recovery.
opinionPaula Escobar12:49 ↗
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