The Society of Surgical Oncology, inc.
The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Update on the Feasibility and Progress on Robotic Breast Surgery

Antonio Toesca MD, Alessandra Invento MD, Giulia Massari MD, Antonia Girardi MD, Nickolas Peradze MD, Germana Lissidini MD, Claudia Sangalli M.Sc., Patrick Maisonneuve PhD, Andrea Manconi MD, Alessandra Gottardi MD, Jennifer L. Baker MD, Luca Bottiglieri MD, Paola Naninato MD, Gabriel Farante MD, Francesca Magnoni MD, Alessandra De Scalzi MD, Giovanni Corso MD, Marco Colleoni MD, Francesca De Lore
Breast Oncology
Volume 26, Issue 10 / October , 2019

Abstract

Background

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.

Objective

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.

Methods

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.

Results

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%).

Conclusion

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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