Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with Gel Implant: Technique, Preliminary Results and Patient-Reported Cosmetic Outcome
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Experience with application of a robotic surgery platform in the management of breast cancer is limited. The preliminary results of the robotic nipple-sparing mastectomy (R-NSM) and immediate breast reconstruction (IBR) with Gel implant procedure are reported.
The medical records of patients from a single institution who underwent an R-NSM and IBR with Gel implant procedure for breast cancer during the period March 2017 to February 2018 were assessed. Data on clinicopathologic characteristics, type of surgery, complications, and recurrence were analyzed to determine the effectiveness and oncologic safety of R-NSM. Patient-reported cosmetic outcome results were obtained.
A total of 22 patients who received 23 R-NSM and IBR with Gel implant procedures were analyzed. The mean operation time for R-NSM was 118.8 ± 50.6 min, and 74.5 ± 26.6 min for Gel implant reconstruction. Docking time quickly dropped from 20 to 6–8 min, and the time needed to complete R-NSM was usually completed within 100 min after accumulation of case experience. Mean blood loss was 37 ± 38.2 mL, and the positive surgical margin rate was 0%. Three (13%) patients had transit nipple ischemia change, and no total nipple-areolar complex necrosis cases were observed. No local recurrence or mortality was found during a mean 6.9 ± 3.5 months of follow-up. All 22 patients were satisfied with the postoperative aesthetic outcome.
From our preliminary experience, R-NSM and IBR with Gel implant is a safe procedure, with good cosmetic results, and could be a promising new technique for breast cancer patients indicated for mastectomy.
The authors would like thank Yun-Ting Chang and Shun-Ing Tsai for their assistance in this study.
This study was funded by the Ministry of Science and Technology of Taiwan (funding number: MOST 107-2314-B-371-006), and was sponsored by research funding provided by the CCH (104-CCH-ICO-006, 105-CCH-PRJ-003, 105-CCH-IRP-025, and 106-CCH-IRP-015).
Hung-Wen Lai, Shou-Tung Chen, Shih-Lung Lin, Chih-Jung Chen, Ya-Ling Lin, Shu-Hsin Pai, Dar-Ren Chen, and Shou-Jen Kuo have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MP4 52647 kb)
- 3.Fan LJ, Jiang J, Yang XH, Zhang Y, Li XG, Chen XC, et al. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer. Chin Med J (Engl) 2009;122(24):2945-2950.Google Scholar
- 5.Lai HW, Chen ST, Chen DR, Chen SL, Chang TW, Kuo SJ, et al. Current trends in and indications for endoscopy-assisted breast surgery for breast cancer: results from a six-year study conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group. PLoS ONE. 2016;11(3):e0150310.CrossRefGoogle Scholar
- 8.Lai HW, Lin SL, Chen ST, Kuok KM, Chen SL, Lin YL, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol. 2018;25(5):1340–1349.CrossRefGoogle Scholar
- 20.Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21(3):704–716.CrossRefGoogle Scholar
- 21.NCCN Clinical Practice Guidelines in Oncology—Breast Cancer. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf.
- 22.Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ. Strategies for subtypes: dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22(8):1736–1747.CrossRefGoogle Scholar