Robotic nipple-sparing mastectomy (RNSM) may allow for more precise anatomic dissection and improved cosmetic outcomes over conventional open nipple-sparing mastectomy; however, data regarding the feasibility and safety of the procedure are limited.
The aim of this study was to present and discuss perioperative surgical outcomes and early oncologic follow-up data on consecutive patients undergoing RNSM from June 2014 to January 2019.
Patients underwent RNSM and immediate robotic breast reconstruction through an axillary incision at a single institution. Perioperative data, complications at 3 months postoperatively, pathological data, and adjuvant therapies were recorded. Local recurrence-free, disease-free, and overall survival were analyzed.
Overall, 73 women underwent 94 RNSM procedures. Indications were invasive breast cancer in 39 patients, ductal carcinoma in situ in 17 patients, and BRCA mutation in 17 patients. Mean surgery time was 3 h and 32 min. One-step reconstruction with implant occurred in 89.4% of procedures. The rate of complications requiring reoperation was 4.3%, and the rate of flap or nipple necrosis was 1.1%. Median follow-up was 19 months (range 3.1–44.8). No local recurrences occurred. Overall survival at 12, 24, or 60 months was 98% (95% confidence interval 86–100%).
We observed a low complication rate in 94 consecutive RNSM procedures, demonstrating the procedure is technically feasible and safe. We found no early local failures at 19 months follow-up. Long-term follow-up is needed to confirm oncologic safety. Future clinical trials to study the advantages and disadvantages of RNSM are warranted.
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The authors thank the IEO.CCM Foundation for supporting this study.
Antonio Toesca, Alessandra Invento, Giulia Massari, Antonia Girardi, Nickolas Peradze, Germana Lissidini, Claudia Sangalli, Patrick Maisonneuve, Andrea Manconi, Alessandra Gottardi, Jennifer L. Baker, Luca Bottiglieri, Paola Naninato, Gabriel Farante, Francesca Magnoni, Alessandra De Scalzi, Giovanni Corso, Marco Colleoni, Francesca De Lorenzi, Virgilio Sacchini, Viviana Galimberti, Mattia Intra, Mario Rietjens, and Paolo Veronesi declare that they have no conflicts of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Toesca, A., Invento, A., Massari, G. et al. Update on the Feasibility and Progress on Robotic Breast Surgery. Ann Surg Oncol 26, 3046–3051 (2019). https://doi.org/10.1245/s10434-019-07590-7