Objective To explore the clinical and aesthetic results of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction (IBBR) for breast cancer patients. MethodsThe clinical data of consecutive female patients who underwent single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral IBBR from May 2020 to December 2022 were retrospectively analyzed. The patient demographics, perioperative parameters, complications and aesthetic results were collected. Results A total of 62 patients (74 breasts) were included. The mean age of patients was 39.0±7.8 years. The total mean operation time was 185.2±45.5 minutes. Five (8.1%) patients suffered from surgical complications. Two (3.2%) patients experienced major complications, and 3 (4.8%) suffered from minor complications. No patient experienced partial nipple-areola complex necrosis. Seventeen (27.4%) patients experienced implant related complications, of which 11 (17.7%) experienced capsular contracture. During a median follow-up time of 30 months, no patients experienced locoregional recurrence, distant metastasis and death. Thirty-seven (88.1%) patients evaluated their breasts as good or excellent. In the surgeon-reported cosmetic results, 40 (95.2%) patients achieved excellent or good results. ConclusionThe surgery is characterized by minimal trauma, short operating time, reliable safety and satisfactory aesthetic effect for small and no or mild ptosis breast patients, deserving further promotion.