Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with Gel Implant: Technique, Preliminary Results and Patient-Reported Cosmetic Outcome

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgement

The authors would like thank Yun-Ting Chang and Shun-Ing Tsai for their assistance in this study.

Funding

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).

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Correspondence to Hung-Wen Lai MD, PhD.

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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.

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Lai, H., Chen, S., Lin, S. et al. Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with Gel Implant: Technique, Preliminary Results and Patient-Reported Cosmetic Outcome. Ann Surg Oncol 26, 42–52 (2019). https://doi.org/10.1245/s10434-018-6704-2

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Keywords

  • Immediate Breast Reconstruction (IBR)
  • Nipple-sparing Mastectomy
  • Postoperative Aesthetic Results
  • Breast Cancer
  • Breast Skin Flaps