Introduction Movin forward from VNOTES technics in hysterectomy to a concept of No Scar in Breast Surgery and exploring the optimisation of vision in Nipple Skin sparing Mastectomy during prophylactic Mastectomy

Methods this is a continuous series of a single institution and a single surgeons study. 25 patients with fully validate indications of prophylactic mastectomy underwent for assisted total laparoscopic skin sparing mastectomy and immediate reconstruction by a fully train single surgeon in reconstructive surgery and also fully train surgeon with more than 400 proceduresof laparoscopic abdominal single port ‘ myomectomy, borderline ovarian staging, laparoscopic assisted vaginal hysterectomy) We are describing our step by step technics the procedure is first described Dissection of the outter quadrant of the breast with scissors, then we put the single port and then we follow the procedure with endoscopic assistance and bipolar The first 7 patients was done by single port with assistance of an additionnal 3 mm port the second serie of 7 patients underwent laparoscopic assistance for the dissection of the NAC and inner part of the breast The last and recent serie of 11 patients underwent fully assisted procedure The removal of speciment is done in endobag without morcellation the insertion of the implant is challenging

Results All the patients underwents a complete procedure without a major oprétaive time-No immediate or Late complication occurs due to the technics patiente satisfaction is good

Conclusion/Implications The operation is safely feasible more cases are needed to validate that very interesting new technics