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Annals of Surgical Oncology

, Volume 25, Issue 9, pp 2579–2586 | Cite as

Robotic Prophylactic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: A Prospective Study

  • Benjamin Sarfati
  • Samuel StrukEmail author
  • Nicolas Leymarie
  • Jean-François Honart
  • Heba Alkhashnam
  • Kim Tran de Fremicourt
  • Angelica Conversano
  • Françoise Rimareix
  • Marie Simon
  • Stefan Michiels
  • Frédéric Kolb
Breast Oncology

Abstract

Background

Robotic nipple-sparing mastectomy (RNSM) could be a significant advancement in the treatment of breast cancers and prophylaxis because the mastectomy is performed without leaving any scar on the breast. The aim of this study was to assess the feasibility and the safety of RNSM with immediate prosthetic breast reconstruction (IPBR).

Methods

In this prospective study, RNSM with IPBR was offered to patients with breast cup size A, B or C and ptosis grade ≤ 2. In case of oncologic surgery, RNSM was proposed only if the tumor was located more than 2 cm away from the nipple-areola complex (NAC) and if postoperative radiation was not indicated. In case of prophylactic surgery, RNSM was proposed only if a high-risk genetic mutation had been identified. The primary endpoint was the rate of skin or NAC necrosis. The rate of conversion to open technique, the duration of the procedure, and postoperative complications were also analyzed.

Results

Sixty-three RNSM with IPBR were performed in 33 patients. There were no cases of mastectomy skin flap or NAC necrosis. We had to convert to an open technique in one case (1.6%). Three infections occurred (4.8%), one leading to implant loss (1.6%). No other major complications were observed.

Conclusions

Preliminary data attest to the feasibility, the reproducibility, and the safety of this approach. However, long-term data are needed to confirm the oncological safety and the esthetic stability of the result.

Trial registration identifier NCT02673268.

Notes

Acknowledgment

The authors thank the members of the IDMC and Anthony Mangin for data management.

Supplementary material

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Supplemental Fig. 1 Preoperative drawings. A lateral-thoracic approach is associated with a high vertical scar of 3 to 5 cm, located within the footprint of the bra, with a subcentimeter vertical scar, located 8 to 9 cm below the previous incision. These incisions are located 6 to 7 cm posterior from the lateral-mammary fold (PNG 1404 kb)
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Supplemental Fig. 2 Robot docking. Robot docking is guided by the target sign, which has to be aligned both with the skin incision and the nipple (PNG 1726 kb)
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Supplemental Fig. 3 Carbon dioxide insufflation. Carbon dioxide insufflation creates a working space and replaces the retractors used in the open technique (PNG 1495 kb)
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Supplemental Fig. 4 Robotic dissection of the gland. Dissection is performed with monopolar-curved scissors whereas traction, counter-traction, exposure, and cauterization are carried out using bipolar grasping forceps. Subcutaneous dissection of the gland (A) is completed in a lateral to medial direction, up to the limits of the gland. Then, the gland is separated from the pectoralis major muscle (B) in a lateral to medial direction (PNG 1015 kb)
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Supplemental Fig. 5 Preoperative photographs of the 14th patient (PNG 1012 kb)
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Supplemental Fig. 6 Three-month postoperative photographs after bilateral RNSM with IPBR (PNG 1023 kb)
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Supplemental Fig. 7 Appearance of the scar (PNG 1352 kb)
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Supplemental Fig. 8 Preoperative photographs of the 16th patient(PNG 1079 kb)
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Supplemental Fig. 9 Three-month postoperative photographs after bilateral RNSM with IPBR (PNG 1063 kb)
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Supplemental Fig. 10 Preoperative photographs of the 19th patient (PNG 1040 kb)
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Supplemental Fig. 11 Three-month postoperative photographs after bilateral RNSM with IPBR (PNG 1008 kb)
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Supplemental Fig. 12 Preoperative photographs of the 20th patient (PNG 1019 kb)
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Supplemental Fig. 13 Three-month postoperative photographs after bilateral RNSM with IPBR (PNG 950 kb)
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Supplemental Fig. 14 Appearance of the scar (PNG 1343 kb)
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Supplemental Fig. 15 Preoperative photographs of the 25th patient (PNG 1041 kb)
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Supplemental Fig. 16 Three-month postoperative photographs after bilateral RNSM with IPBR (PNG 993 kb)
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Supplemental Fig. 17 Appearance of the scar (PNG 1327 kb)
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Supplemental Fig. 18 Six months after the first fat grafting session (PNG 861 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Benjamin Sarfati
    • 1
  • Samuel Struk
    • 1
    Email author
  • Nicolas Leymarie
    • 1
  • Jean-François Honart
    • 1
  • Heba Alkhashnam
    • 1
  • Kim Tran de Fremicourt
    • 1
  • Angelica Conversano
    • 1
  • Françoise Rimareix
    • 1
  • Marie Simon
    • 2
    • 3
  • Stefan Michiels
    • 2
    • 3
  • Frédéric Kolb
    • 1
  1. 1.Service de Chirurgie Plastique et ReconstructriceGustave RoussyVillejuifFrance
  2. 2.Service de Biostatistique et d’EpidémiologieGustave RoussyVillejuifFrance
  3. 3.CESP, Inserm U1018Univ. Paris Sud, Univ. Paris-SaclayVillejuifFrance

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