Robotic Nipple-sparing Mastectomy and Immediate Breast Reconstruction with Gel Implant

Hung-Wen Lai, Shih-Lung Lin, Shou-Tung Chen, Shu-Ling Chen, Ya-Ling Lin, Dar-Ren Chen, Shou-Jen Kuo, Hung-Wen Lai, Shih-Lung Lin, Shou-Tung Chen, Shu-Ling Chen, Ya-Ling Lin, Dar-Ren Chen, Shou-Jen Kuo

Abstract

Background: The experience of application of robotic surgery platform in the management of breast cancer was limited. The preliminary experience and results of robotic nipple-sparing mastectomy (R-NSM) and immediate breast reconstruction (IBR) with Gel implant was reported.

Methods: The medical records of patients who underwent R-NSM and IBR with Gel implant for breast cancer during the period March 2017 to October 2017 were collected from single institution. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications, and recurrence were analyzed to determine the effectiveness and oncologic safety of R-NSM. Patients' oriented cosmetic outcome report was also obtained.

Results: A total of 15 patients was analyzed, and the mean age of them was 46.5 ± 10.0 years. The pathologic stage was 30.8% ductal carcinoma in situ, 30.8% stage I, 30.8% stage II, and 7.7% stage III. The mean operation time was 282.8 ± 70.4 minutes, and mean hospital stay was 6.7 ± 1.2 days. The positive surgical margin rate was 0%. One patient suffered from delayed axillary wound healing. Two patients (13.3%) with transit nipple ischemia change, but no total nipple areolar complex necrosis case was observed. No local recurrence, distant metastasis, or case mortality was found during mean 6.3 ± 2.1 months follow-up. All 15 patients were satisfied with the postoperative aesthetic outcome.

Conclusion: From our preliminary experience, R-NSM and IBR with Gel implant is a safe procedure, with good cosmetic results, and could be a promising new technique for breast cancer patients indicated for mastectomy.

Figures

Fig. 1.
Fig. 1.
Demonstration technique tips and postoperative outcome for R-NSM and IBR with Gel implant. A, The position of patients for R-NSM. The operating side shoulder was elevated to 30 degree with draping (or the arm in operating field was adducted after axillary surgery) to prevent conflict between the operating table and docking of robotic surgery system. B, Illustration of insertion of single port, and robotic surgical platform with da Vinci Si system. Video camera, monopolar scissor, and prograsp forceps. C, The setting of robotic side cart is positioned posterior to the patient with the 2 robotic arms and the endoscope extending over the patient in proximity to the ports. In this position, the arms are aligned with the plane of the breast, nearly parallel to the floor, and the ports are docked to the robotic arms. D, Postoperative lateral view showed that the wound was small and well hidden in the inconspicuous axilla region.
Video Graphic 1.
Video Graphic 1.
See video, Supplemental Digital Content 1, which discusses details of R-NSM. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A789.

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Source: PubMed

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