To investigate the clinical application and outcomes of endoscopic nipple-sparing mastectomy （NSM） and immediate reconstruction in early breast cancer.

The clinical data of 38 patients with early breast cancer who underwent surgery in the Women and Children's Hospital of Chongqing Medical University from June 2020 to June 2024 were retrospectively analyzed. According to the type of surgery，patients were divided into the endoscopic surgery group （n=25） and the open surgery group （n=13）. Operation time，intraoperative blood loss were compared between two groups using independent sample t test； hospital stay，preoperative and postoperative patient satisfaction with breast appearance were compared between two groups using the nonparametric Mann–Whitney test，and pre- and postoperative patient satisfaction within-group was compared by paired rank-sum test.

Operation time was significantly longer in the endoscopic surgery group than in the open surgery group ［（165.84±16.30） min vs （99.69±12.35） min，t=12.813，P<0.001］. Intraoperative blood loss and postoperative hospital stay showed no statistically significant difference（t=1.456，P=0.154；Z=-0.135，P=0.199）. The patient satisfaction with breast appearance showed no significant differences between two groups before operation［48.00（39.00，55.50） vs 53.00（44.00，58.00），Z=-0.856，P＝0.392）］，while postoperative satisfaction was significantly higher in the endoscopic surgery group ［42.00（40.00，45.50） vs 38.00（33.00，43.00），Z=-2.501，P=0.012］. The patient satisfaction with breast appearance after surgery was significantly better than that before surgery （Z=-2.432，-2.906，P=0.015，0.004）.

The endoscope-assisted NSM and immediate reconstruction in early breast cancer has the advantages of good aesthetic effect，safety and operability，and high postoperative patient satisfaction worthy of clinical application.