Three Strategic Pillars for Implementing Endoscopic Nipple-Sparing Mastectomy.

Introduction: Surgical treatment of breast cancer has evolved from radical surgery to increasingly less invasive techniques, including nipple-sparing mastectomy (NSM), and more recently toward minimally invasive breast surgery (MIB), both endoscopic and robotic, particularly in high-volume centers, demonstrating encouraging oncologic and reconstructive outcomes in selected patients. Objective: To present a structured and practical guided framework, describing the three fundamental strategic axes for the safe implementation of endoscopic mastectomy, based on the experience of a pioneering center. Methods: We propose a structured model focused on: (1) clinical and oncologic foundations; (2) technical standardization and surgical logistics; and (3) outcomes assessment, training, and reproducibility. The center's initial experience, the systematization of the implementation process, and a reflection on its applicability are presented. Results: A patient selection protocol, an equipment-and-roles checklist, standardized technical steps, and a plan for data capture and training are provided. Conclusions: Endoscopic mastectomy can be successfully implemented within a structured institutional setting, with specialized training and appropriate equipment. This article offers an actionable pathway for other centers seeking to adopt this technique.