Robotic nipple-sparing mastectomy with immediate prosthetic reconstruction: A prospective study about 138 consecutive procedures

Background and purpose: Robotic nipple-sparing mastectomy (RNSM) is becoming popular for the treatment of breast cancers because of the absence of scars on the breasts. The aim of this study is to assess the feasibility and the safety of RNSM with immediate prosthetic breast reconstruction (IPBR). Methods: In this single-arm, monocentric and prospective study, RNSM with IPBR was offered, in case of prophylactic or therapeutic surgery of breast cancers, to patients with breast cup ≤ C and moderate ptosis. The primary goal was the rate of full thickness skin or areola necrosis. As a second objective we meant to assess the rate of conversion to open technique and postoperative complications. We also analysed pre- and postoperative BREAST-Q scores and aesthetic outcomes by submitting them to independent surgeons and to the patients themselves. Results: In total, 138 RNSM with IPBR were performed in 79 patients between December 2015 and January 2020. There were two cases of full thickness skin or areolar necrosis (1.5%), nine infections (6.5%), and nine implants loss (6.5%). We had to switch to an open technique in two cases (1.5%) and in four cases we had to surgically drain four hematoma (2.9%). The patient's physical and sexual well-being evaluated by BREAST-Q was not impacted by the surgery. The aesthetical outcomes are satisfying for both the patients and the main surgeon as well as for a panel of independent plastic surgeons. Conclusions: This study does attest to the feasibility, the reproducibility, and the safety of this approach.