Abstract
PurposeThis study is to directly compare surgical outcomes between conventional nipple-sparing mastectomy (CNSM) and robot-assisted nipple-sparing mastectomy (RNSM).Materials and MethodFor this case–control study, 369 cases of 333 patients who underwent CNSM or RNSM with immediate reconstruction between November 2016 and January 2019 at Severance Hospital in Seoul, Republic of Korea were reviewed. Patients with stage IV breast cancer (n = 1), receiving neoadjuvant chemotherapy (n = 43), or subjected to previous operations (n = 14) or radiotherapy on the breasts were excluded. The main outcomes were comparing rates of post-operative complications, of high-grade post-operative complications as defined by the Clavien-Dindo classification, and nipple necrosis between the CNSM and the RNSM groups.ResultsA total of 311 cases, including 270 CNSMs and 41 RNSMs, were analyzed. The rates of post-operative nipple necrosis (p = 0.026, 2.4 vs. 15.2%) and of high-grade post-operative complications (p = 0.031, 34.8 vs. 17.1%) in the RNSM group were significantly lower than those in the CNSM group.ConclusionRNSM was associated with lower rates of high-grade post-operative complications and nipple necrosis than CNSM for patients with small breast volumes and less ptotic breasts.
Highlights
Nipple-sparing mastectomy (NSM) has been widely applied to women with early breast cancer or BRCA 1/2 mutations [1,2,3,4]
There were no differences in clinicopathologic features between the conventional nipple-sparing mastectomy (CNSM) and robot-assisted nipple-sparing mastectomy (RNSM) groups, except in breast volumes, laterality, and ptosis
Ptotic breasts were more frequent and breast volumes were larger in the CNSM group
Summary
Nipple-sparing mastectomy (NSM) has been widely applied to women with early breast cancer or BRCA 1/2 mutations [1,2,3,4]. Nipple necrosis is one of the most common complications after NSM [1, 2, 10, 11]. Previous studies reported 0–48% of nipple ischemia or nipple necrosis in patients undergoing NSM with immediate reconstruction [1, 12]. In order to reduce nipple ischemia or necrosis, various techniques have been proposed in previous studies [12, 13]. Rusby et al showed that placement of incisions far from the NAC and reconstruction using a tissue expander (T/E) reduced the risk of NAC necrosis [12]. Petit et al reported that leaving a layer 5 mm of glandular tissue beneath the NAC for preserving its blood supply is beneficial to reduce NAC necrosis [13]. There is no universal solution for reducing nipple necrosis after NSM
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