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Update on the Feasibility and Progress on Robotic Breast Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgment

The authors thank the IEO.CCM Foundation for supporting this study.

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Authors and Affiliations

  1. Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy

    Antonio Toesca MD, Alessandra Invento MD, Giulia Massari MD, Antonia Girardi MD, Nickolas Peradze MD, Germana Lissidini MD, Paola Naninato MD, Gabriel Farante MD, Francesca Magnoni MD, Alessandra De Scalzi MD, Giovanni Corso MD, Virgilio Sacchini MD, Viviana Galimberti MD, Mattia Intra MD & Paolo Veronesi MD

  2. Data Management, European Institute of Oncology IRCCS, Milan, Italy

    Claudia Sangalli M.Sc.

  3. Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy

    Patrick Maisonneuve PhD

  4. Division of Plastic and Reconstructive Surgery, European Institute of Oncology IRCCS, Milan, Italy

    Andrea Manconi MD, Alessandra Gottardi MD, Francesca De Lorenzi MD & Mario Rietjens MD

  5. Breast Surgery Division, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Jennifer L. Baker MD

  6. Division of Pathology, European Institute of Oncology IRCC, Milan, Italy

    Luca Bottiglieri MD

  7. Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy

    Marco Colleoni MD

  8. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Virgilio Sacchini MD

  9. University of Milan School of Medicine, Milan, Italy

    Virgilio Sacchini MD & Paolo Veronesi MD

Authors
  1. Antonio Toesca MD
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  2. Alessandra Invento MD
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  3. Giulia Massari MD
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  4. Antonia Girardi MD
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  6. Germana Lissidini MD
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  7. Claudia Sangalli M.Sc.
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  8. Patrick Maisonneuve PhD
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  9. Andrea Manconi MD
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  10. Alessandra Gottardi MD
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  11. Jennifer L. Baker MD
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  12. Luca Bottiglieri MD
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  13. Paola Naninato MD
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  14. Gabriel Farante MD
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  15. Francesca Magnoni MD
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  16. Alessandra De Scalzi MD
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  17. Giovanni Corso MD
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  18. Marco Colleoni MD
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  19. Francesca De Lorenzi MD
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  20. Virgilio Sacchini MD
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  21. Viviana Galimberti MD
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  22. Mattia Intra MD
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  23. Mario Rietjens MD
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  24. Paolo Veronesi MD
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Corresponding author

Correspondence to Antonio Toesca MD.

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Disclosures

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.

Ethical Approval

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

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  • DOI: https://doi.org/10.1245/s10434-019-07590-7

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