Robotic-assisted nipple-sparing mastectomy

Abstract

Aim: With advancement and popularization of the technology, robotic‐assisted nipple‐sparing mastectomy with immediate implant reconstruction is now increasingly practiced for selected breast cancer patients. Methods: A 42‐year‐old lady, with known BRCA2 mutation, had a history of left breast cancer treated with neoadjuvant systemic therapy followed by lumpectomy and sentinel lymph node biopsy (SLNB), and adjuvant radiotherapy in 2014. During surveillance, she decided to have risk‐reducing bilateral nipple‐sparing mastectomy with immediate implant reconstruction in August 2019. For the procedure, patient was in supine position with pre‐operative marking. Oblique left axillary incision with length of 5 cm along the old SLNB scar was made and a single port was inserted (Glove Port, Nelis, Gyeonggi‐do, Korea). Robot (da Vinci Xi, Intuitive Surgical) was docked and mastectomy was performed with three robotic arms (one for camera, right with monopolar scissors, left with ProGrasp). Anterior skin flap was dissected followed by posterior dissection to detach breast gland from pectoralis major muscle. Retro‐aerolar tissue sent for frozen section was confirmed to be negative for malignancy. Subpectoral muscle pocket was created to facilitate implant insertion. Robot was undocked and the breast was removed via the axillary wound. Right side operation was performed in a similar manner. Immediate breast reconstruction with subpectoral implant insertion followed. Results: The patient had good recovery without complications. Cosmetic outcome was satisfactory. Conclusions: Robotic‐assisted nipple‐sparing mastectomy with immediate implant reconstruction is a safe and feasible technique with small and well‐hidden scar. With maturation of skills it could be beneficial for patients with breast cancer.