Robotic Prophylactic Nipple-Sparing Mastectomy with Immediate Prosthetic Breast Reconstruction: A Prospective Study

• Published in: Annals of surgical oncology 2018-09, Vol.25 (9), p.2579-2586
• Main Authors: Sarfati, Benjamin, Struk, Samuel, Leymarie, Nicolas, Honart, Jean-François, Alkhashnam, Heba, Tran de Fremicourt, Kim, Conversano, Angelica, Rimareix, Françoise, Simon, Marie, Michiels, Stefan, Kolb, Frédéric
• Format: Article
• Language: English
• Subjects: Adult; Breast; Breast cancer; Breast Oncology; Conversion to Open Surgery; Feasibility Studies; Female; Gangrene; Humans; Infection - etiology; Mammaplasty - adverse effects; Mammaplasty - methods; Mastectomy; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT02673268; Necrosis; Necrosis - etiology; Nipples - pathology; Nipples - surgery; Oncology; Organ Sparing Treatments - adverse effects; Organ Sparing Treatments - methods; Patients; Postoperative Complications - etiology; Postoperative Complications - surgery; Prophylactic Mastectomy - adverse effects; Prophylactic Mastectomy - methods; Prophylaxis; Prospective Studies; Prostheses; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Safety; Skin; Surgery; Surgical Flaps - adverse effects; Surgical Oncology; Time Factors; Young Adult
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6555-x

Background Robotic nipple-sparing mastectomy (RNSM) could be a significant advancement in the treatment of breast cancers and prophylaxis because the mastectomy is performed without leaving any scar on the breast. The aim of this study was to assess the feasibility and the safety of RNSM with immediate prosthetic breast reconstruction (IPBR). Methods In this prospective study, RNSM with IPBR was offered to patients with breast cup size A, B or C and ptosis grade ≤ 2. In case of oncologic surgery, RNSM was proposed only if the tumor was located more than 2 cm away from the nipple-areola complex (NAC) and if postoperative radiation was not indicated. In case of prophylactic surgery, RNSM was proposed only if a high-risk genetic mutation had been identified. The primary endpoint was the rate of skin or NAC necrosis. The rate of conversion to open technique, the duration of the procedure, and postoperative complications were also analyzed. Results Sixty-three RNSM with IPBR were performed in 33 patients. There were no cases of mastectomy skin flap or NAC necrosis. We had to convert to an open technique in one case (1.6%). Three infections occurred (4.8%), one leading to implant loss (1.6%). No other major complications were observed. Conclusions Preliminary data attest to the feasibility, the reproducibility, and the safety of this approach. However, long-term data are needed to confirm the oncological safety and the esthetic stability of the result. Trial registration identifier NCT02673268.