INVISISCAR™ Endoscopic Nipple Sparing Mastectomy (ENSM)

Advanced scar‑sparing prophylactic mastectomy surgery by the UK’s leading minimally invasive breast surgeon

INVISISCAR™ Endoscopic Nipple‑Sparing Mastectomy (ENSM) is an innovative, minimally invasive approach to mastectomy designed to remove breast tissue while preserving the natural skin envelope and nipple‑areola complex, with the scar hidden away from the breast. Reconstruction is performed immediately using Motiva® breast implants, delivering a natural shape with a modern, safety‑focused implant philosophy.

This highly specialised procedure is offered by Mr Rob Milligan, Consultant Oncoplastic & Cosmetic Breast Surgeon in Newcastle upon Tyne and Gateshead, who is widely recognised as the leading UK expert in minimally invasive breast surgery. Mr Milligan was the first surgeon in the UK to perform endoscopic nipple‑sparing mastectomy, and he teaches and presents this technique internationally.

What is INVISISCAR™ Endoscopic Nipple Sparing Mastectomy?

Traditional mastectomy involves visible scars on the breast itself. INVISISCAR™ ENSM is different.

Using high‑definition endoscopic (keyhole) surgery, the entire mastectomy is performed through a small (3-4cm) incision, typically hidden in the armpit (axilla). A camera provides magnified visualisation of all structures, allowing precise and meticulous removal of breast tissue while preserving:

Immediate reconstruction is performed in the same operation using Motiva® implants, avoiding expanders and minimising disruption to the breast shape.

The result is a breast with no visible scar on the breast itself, hence the name INVISISCAR™.

Who is this procedure for?

INVISISCAR™ ENSM may be suitable for:

Women with BRCA1, BRCA2 or other high risk genetic mutations who are considering risk reducing (prophylactic) mastectomy
Selected patients with early stage breast cancer where nipple sparing surgery is oncologically appropriate (not currently offered by Mr Milligan in the private sector)
Patients seeking the most advanced scar minimising surgical option
Women who value both oncological safety and cosmetic outcome

Every patient undergoes a detailed consultation and multidisciplinary discussion to ensure this approach is safe and suitable.

Motiva® Breast Implants – Why they are used

Motiva® implants are chosen for INVISISCAR™ ENSM because they complement the minimally invasive philosophy of the procedure.

Key features include:

ProgressiveGel® technology for a natural feel
SmoothSilk® surface designed to reduce inflammatory response
Advanced safety features including implant traceability
Excellent aesthetic outcomes in implant‑based reconstruction

Motiva® implants allow immediate reconstruction without expanders in appropriately selected patients, helping achieve a soft, natural breast shape from the outset.

Why choose endoscopic nipple sparing mastectomy?

1. No visible breast scar
The incision is hidden in the armpit, leaving the breast skin untouched.

2. Preservation of nipple and skin
This helps maintain a natural breast appearance and body image.

3. Better Patient Satisfaction
Studies have shown improved patient cosmetic satisfaction when their mastectomy has been performed endoscopically rather than by the conventional method.

4. High definition visual control
Endoscopic magnification allows precise dissection and excellent visualisation of anatomy.

5. Immediate reconstruction
Reconstruction with Motiva® implants is performed in the same operation.

6. Faster recovery
Minimal disruption of breast skin and tissues often leads to reduced pain and quicker return to normal activities.

Mr Rob Milligan – UK leader in minimally invasive breast surgery

Mr Rob Milligan is a Consultant Oncoplastic & Cosmetic Breast Surgeon based at Queen Elizabeth Hospital, Gateshead, and in private practice at Tyneside Surgical Services and Nuffield Health Newcastle.

He is:

The first surgeon in the UK to perform endoscopic nipple‑sparing mastectomy
A national and international teacher and presenter on minimally invasive breast surgery
Actively involved in research, innovation and surgical education
Known for pioneering scar‑minimising techniques including endoscopic breast surgery

Patients from across the UK seek Mr Milligan specifically for his expertise in advanced breast surgery where oncological safety and cosmetic outcome are equally prioritised.

What happens on the day of surgery?

Surgery is performed under general anaesthetic
A small incision is made, usually hidden in the armpit
Endoscopic instruments and a high definition camera are used to perform the mastectomy
The nipple and breast skin are preserved
Immediate reconstruction is performed with Motiva® implants
Drains may be placed temporarily
Most patients are suitable for short stay or day case surgery, depending on individual circumstances

Recovery and aftercare

Most patients are up and moving the same day
Discomfort is usually well controlled with simple pain relief
Drains are usually removed after 7-10 days post-operatively
Return to light activities: 1-2 weeks
Return to work: typically 2-4 weeks (depending on role and recovery)
Exercise: gradually resumed over 6 weeks

Detailed aftercare guidance and follow‑up are provided by Mr Milligan and his specialist breast care team.

Safety and cancer outcomes

Patient safety and oncological outcomes are paramount.

Frequently Asked Questions (FAQ)

Yes, in appropriately selected patients. Safety, cancer clearance, and patient outcomes are the priority.

No visible scars on the breast itself. The incision is usually hidden in the armpit.

Some sensation may be preserved, but changes in nipple sensation are common and vary between individuals.

Endoscopic nipple‑sparing mastectomy is available within the NHS in extremely limited circumstances, due to the highly specialised equipment and training required, and has not yet been rolled out nationally. In the private sector, Mr Milligan offers INVISISCAR™ Endoscopic Nipple‑Sparing Mastectomy for prophylactic (risk‑reducing) surgery only.

Yes, in selected early breast cancer cases where nipple‑sparing surgery is appropriate, although Mr Milligan does not offer this procedure privately for breast cancer.

Motiva® implants offer excellent aesthetic outcomes, a natural feel, and advanced safety features that align with minimally invasive reconstruction.

Costs vary depending on whether surgery is unilateral or bilateral and individual clinical needs. They price will also depend on where you have your surgery performed. A personalised quote is provided following consultation.

Book a consultation

If you are considering risk‑reducing mastectomy or exploring advanced surgical options for breast cancer, a consultation with Mr Rob Milligan will allow you to understand whether INVISISCAR™ Endoscopic Nipple‑Sparing Mastectomy is right for you.

Private consultations available in Newcastle upon Tyne and Gateshead.

Reach Us

If you’re considering a breast augmentation in Newcastle or Gateshead, book a consultation with Mr Milligan to explore your options and receive a personalised treatment plan.

INVISISCAR™ Endoscopic Nipple Sparing Mastectomy (ENSM)

INVISISCAR™ Endoscopic Nipple Sparing Mastectomy (ENSM)