Minimal access nipple-sparing mastectomy - the current European landscape

Abstract

Minimal access nipple-sparing mastectomy (M-NSM), performed with endoscopic systems or with surgical robot assistance, is a novel alternative to the classic approach to nipple-sparing mastectomies. Leading advancements in M-NSM have primarily come from Asia. We gather experts' opinions from six European countries to establish the current status of M-NSM in Europe. An eight-question survey was designed to explore M-NSM's historical background and current standing in various local settings. We collected data from 6 European countries, including Italy, Spain, France, Switzerland, Belgium, and Poland. The number of centers offering M-NSM procedures in each reported country ranges 1-9. The number of procedures performed annually in four centers exceeds 10. In all reported countries, current national breast cancer recommendations do not include M-NSM, and this procedure is not explicitly covered by any of the national health care providers. All experts have indicated the need for training in M-NSM surgery as a primary way to incorporate these techniques as a standard procedure. Minimal access nipple-sparing mastectomy is still a tool used by a narrow group of specialists in Europe. The main obstacle to broader implementation remains the extra cost of M-NSM, which requires reimbursement from the health care providers. Training courses, data collection, and demonstration of its benefits are the key to promoting M-NSM among breast surgeons and patients.

Keywords: endoscopic mastectomy; endoscopic nipple-sparing mastectomy; minimal access nipple-sparing mastectomy; robot-assisted nipple-sparing mastectomy; robotic mastectomy.