Safety and Feasibility of Robotic Nipple-Sparing Mastectomy With Immediate Direct-to-Implant Reconstruction - Insights From the One of the Largest Centers in Asia

Abstract

Background: The use of robotic-assisted nipple-sparing mastectomy (R-NSM) with immediate direct-to-implant (DTI) reconstruction in treatment of breast cancer has been a controversial topic. The adoption of robotic surgery in breast cancer treatment has gained traction globally due to its minimally invasive nature, potential for improved cosmetic outcomes and better intraoperative visualization. This study provides insights on safety and feasibility robotic mastectomy at one of the largest centers in Asia.

Methods: This retrospective study included patients who underwent robotic nipple-sparing mastectomy (R-NSM) with immediate direct-to-implant (DTI) reconstruction from April 2018 to September 2024. Our endpoints were mainly focused on perioperative outcomes, patient satisfaction, and oncologic outcomes.

Results: A total of 266 procedures were included in our series, with 233 patients undergoing unilateral R-NSM with either DTI reconstruction or a tissue expander, and 33 patients underwent surgery on both breasts. Postoperative complications were recorded in 11 patients (4.14 %). The median follow-up of this study is 37.2 ± 23.3 months. Locoregional recurrence (LRR) was observed in 6 patients (2.5 %), with isolated skin recurrence being the most common. Distant metastasis was observed in 9 patients (3.86 %). The 3-year overall survival rate was 98.3 %.

Conclusion: Robotic NSM is a safe and feasible novel minimal invasive surgical approach for breast cancer surgery, providing both excellent cosmetic results and oncological outcomes that are noninferior to conventional or endoscopic approaches.

Keywords: Breast cancer surgery; Local recurrence; Patient report outcome; Robot-assisted nipple sparing mastectomy; Robotic mastectomy.