Postoperative Outcomes of Single-Port Robot-Assisted Versus Conventional Nipple-Sparing Mastectomy with Immediate Reconstruction.

Abstract

Robotic surgery is becoming an increasingly popular option for breast cancer surgery. However, studies comparing the characteristics of single-port robotic-assisted nipple-sparing mastectomy (SP RA-NSM) and conventional nipple-sparing mastectomy (CNSM) are limited. This study aimed to compare the outcomes of SP RA-NSM and CNSM. This study conducted a comparative cross-analysis using propensity score-matching between patients who underwent CNSM (n = 148) and those who underwent SP RA-NSM (n = 148). The initial cohort included 1,512 patients with unilateral breast cancer between October 2020 and April 2024 at Asan Medical Center in Seoul, Republic of Korea (1,208 CNSM patients and 304 SP RA-NSM patients). Propensity score-matching was performed in a 1:1 ratio using age, body mass index, tumor size, and specimen weight as covariates. Both groups had a median age of 46 years at diagnosis and pathologic stages of disease ranging from 0 to II. During surgery, SP RA-NSM resulted in less blood loss than CNSM (0-10 ml [74.3% vs 29.7%], 11-100 ml [25.0% vs 70.3%]; p < 0.001). Postoperative complications were significantly less frequent in the SP RA-NSM group (p = 0.046), and nipple ischemia was absent (0.0% vs 2.7%; p = 0.044). Skin necrosis was slightly higher in CNSM (3.4%) than in SP RA-NSM (0.7%) (p = 0.099). Seroma was less frequent in SP RA-NSM (8.1%) than in CNSM (12.2%), although the difference was not significant (p = 0.248). The SP RA-NSM procedure is a safer and more favorable surgical approach that could serve as a significant alternative to CNSM.