Robot-assisted Nipple-sparing Mastectomy With Immediate Breast Reconstruction: An initial Experience of the Korea Robot-endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG)

OBJECTIVE:The aim of this study was to present the results of early experience of RANSM. BACKGROUND:Robot-assisted nipple-sparing mastectomy (RANSM) improves cosmetic outcomes over conventional nipple-sparing mastectomy (CNSM). However, data on the feasibility and safety of the RANSM are limited. METHODS:Patients who underwent RANSM with immediate breast reconstruction (IBR) as part of the Korea Robot-Endoscopy & Minimal Access Breast Surgery Study Group (KoREa-BSG) from November 2016 to January 2020 were enrolled. Clinicopathologic characteristics, perioperative complications, and operation time were collected. RESULTS:Overall, 73 women underwent 82 RANSM procedures conducted by 11 breast surgeons at eight institutions. The median patient age was 45.0 years old (20–66 years), and 52 (63.4%) patients were premenopausal. Invasive breast cancer was noted in 55 cases (40 cases were stage I, 11 cases were stage II, and four cases were stage III, respectively) and ductal carcinoma in-situ was recorded in 20 cases. Of those, three patients with BRCA1/2 mutation carriers underwent contralateral risk-reducing RANSM. The median length of hospitalization was 11.7 days (5.0–24.0 days). The incision location was the mid-axillary line and the median incision length was 46.3 mm (30.0–60.0 mm). Median total operation time, median total mastectomy time, and median reconstruction time was 322.0 minutes (163.0–796.0 minutes), 190.8 minutes (97.5–325.0 minutes), and 133.6 minutes (45.0–689.0 minutes). Only two cases (2.5%) required re-operation. Nipple ischemia was found in nine cases (10.9%) but only one case (1.2%) required nipple excision given that eight cases (9.7%) resolved spontaneously. Skin ischemia was observed in five cases (6.1%) and only two (2.4%) cases needed skin excision whereas three cases (3.6%) resolved spontaneously. There was no conversion to open surgery or cases of mortality. The mean time for mastectomy among surgeons who performed more than 10 cases was 182.3 minutes (± 53.7, minutes) and 195.4 minutes (± 50.4, minutes). CONCLUSION:This was the first report of RANSM conducted in the KoREa-BSG. RANSM is technically feasible and acceptable with a short learning curve. Further prospective research to evaluate surgical and oncologic outcomes is needed.