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

Sarfati, Benjamin; Struk, Samuel; Leymarie, Nicolas; Honart, Jean-François; Alkhashnam, Héba; Fremicourt, Kim Tran de; Conversano, Angelica; Rimareix, Françoise; Simon, Marie; Michiels, Stefan; Kolb, F.

doi:10.1245/s10434-018-6555-x

Cited by 82 publications

(76 citation statements)

References 19 publications

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“…While performing NSM with conventional retractors, surgeons cannot easily visualize upper quadrants through infra-mammarian fold incision. Endoscopic mastectomy, with/without insufflation, can be performed with rigid tools; however, visibility and access decrease during dissection beyond the dome of the breast, but with DaVinci Xi robotic system, these restrictions can be avoided (21,23,28).…”

Section: Discussionmentioning

confidence: 99%

“…Lai et al (26) have utilized a higher and oblique incision located in the axilla, Toesca et al (21) have performed the incision in the axilla on the mid axillary line, and Park et al (6) have performed a vertical incision on the anterior axillary line but did not mention the exact position. Sarfati et al (23) have performed the incision on the projection of the bra and proposed it could be hidden easily by the patient; however, the surgery was not performed with single incision. In this study, a 5-cm lateral peripheral incision starting from the middle portion of the breast to the cranial direction, which is positioned on the anterior axillary line in parallel to curvature of the breast, was performed.…”

Section: Discussionmentioning

confidence: 99%

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Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection

et al. 2020

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Objective: Loss of breast, which is an important body marking of women, causes a huge decrease in quality of life (QoL) after treatment. In order to overcome this morbidity and increase QoL, nipple sparing mastectomy (NSM) has been developed. Even though the demand for better cosmetic results has yielded endoscopic nipple sparing mastectomy, limitations like unsuitable optical window and limited manual control of rigid-tip instruments, and struggling to keep dissection space have led robotic nipple sparing mastectomy (rNSM) to be developed. Material and Methods: Records of three patients who underwent to rNSM for invasive breast carcinoma with DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) in affiliated hospitals of Acıbadem Mehmet Ali Aydınlar University, Research Institute of Senology in 2018 were investigated retrospectively. In all breasts (n= 4), dissection was started from the posterior side of breast. Results: In the unit, 738 breast cancer patients underwent surgery between 2018 and 2019 with an NSM ratio of 31.4% (n= 232). Of these patients, three underwent rNSM with DaVinci Xi robotic system. The operation was performed on the left breast in one patient, right in one, and bilateral in one patient. Only in patient #2, who was a neoadjuvant chemotherapy recipient, seroma was observed six weeks after surgery (3 weeks after removal of drains) and spontaneously resolved in 4 weeks. No other complication was seen in all patients. In the follow-up period of median 21 months, no loco-regional recurrence or distant metastasis was seen. Conclusion: A single incision robotic mastectomy can be performed easily and safely when the dissection starts from the pre-pectoral plane rather than the subcutaneous plane.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection

et al. 2020

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“…The technique has been described using the da Vinci Xi and Si Surgical Systems (Intuitive Surgical, Sunnyvale, CA) and involves a small incision in the axilla, varying from 2.5 to 4 cm, and a possible second port incision, measuring 0.8 cm in length 40‐42 . The complication rate and short‐term oncologic outcomes are similar between the robotic and open approach, 43‐45 and patients are satisfied with their cosmetic outcome 42 . However, the increased cost and operative time of the robotic approach are significant concerns, and long‐term data is still needed to confirm oncologic and aesthetic outcomes.…”

Section: Techniquementioning

confidence: 99%

The modern approach to the nipple‐sparing mastectomy

Kopkash

Sisco

Poli

et al. 2020

Journal of Surgical Oncology

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A modern perspective on the nipple-sparing mastectomy (NSM) looking at current indications as well as the most up-to-date evidence both in the literature and from our institution. There is an in-depth description of our NSM technique and an overview of alternative approaches, including the robotic technique. The complicated concept of the learning curve is addressed and ideas on how to train other NSM adopters. K E Y W O R D S breast cancer risk reduction, breast cancer surgery, nipple-sparing mastectomy, robotic nipple-sparing mastectomy, surgical technique

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“…Moreover, most of incisions used are visible and considered as unaesthetic by patients. Robotics offer interesting prospects for improving visibility and increasing maneuverability, allowing movement of the incision to the axillary area and limiting subcutaneous dissection in the breast area, which has adverse effects on cutaneous vascularization [14][15][16][17][18]. But this is a highly specialized, expensive and largely unavailable technique.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report

et al. 2019

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Unusual setting of medical care Background: Technical innovations allow endoscopic nipple-sparing mastectomy (NSM), which is well tolerated and associated with greater patient satisfaction. Endoscopic technique did not have wide diffusion; many centers have abandoned this technique because of technical challenges. Implant-based reconstruction (IBR) remains the most common form of breast reconstruction. Current techniques involve partial or total coverage of the implant with pectoralis major muscle to prevent exposure or infection. Muscle dissection has functional and cosmetic consequences. Case Report: We present a case of 45-year-old patient presenting with personal history of right breast cancer. The patient requested left prophylactic mastectomy. We used a 4 cm-long single hidden scar on axillary line. Endoscopic nipple-sparing mastectomy was done using a single port with 3 sleeves. Immediate breast reconstruction was performed by inserting a silicon implant in prepectoral plane without Acellular Dermal Matrix (ADM). At 6 months postoperatively, no complication had been reported. The patient was satisfied with the result and no further correction was necessary. Conclusions: Endoscopic surgery is a valuable option for nipple-sparing mastectomy. This method is a less expensive alternative technique to robotic approach. It could enable safe prepectoral IBR without placement of ADM and with lower risk of complications.

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

Abstract: 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.

Cited by 82 publications

References 19 publications

Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection

Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection

The modern approach to the nipple‐sparing mastectomy

Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report

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