Related Experiment Video
Updated: Nov 30, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Evaluation of the Learning Curve in Robotic Nipple-sparing Mastectomy for Breast Cancer
Zhu-Jun Loh1, Tzu-Yi Wu2, Fiona Tsui-Fen Cheng3
1Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
Background:
This study discusses the preliminary results of robotic nipple sparing mastectomy (R-NSM) in patients with breast cancer and analyzes the learning curve of the same surgeon in a single medical center.
Patients And Method:
Patients with breast cancer from a single center who received R-NSM between 2018 to 2020 were recruited for clinical and pathologic tumor characteristics including family history, grade, type of tumor, treatment, and outcome. The learning curve for R-NSM was analyzed by using cumulative sum (CUSUM).
Results:
A total of 85 R-NSM procedures from 78 patients were evaluated. In the CUSUM plot analysis of the learning curve, a significant decrease in time for mastectomy, reconstruction, and total operation appeared in the 22nd, 23rd, and 26th procedures, respectively. Patients' body weight, gel implant size, and specimen weight had significant correlations with the time for mastectomy. Four (5.6%) patients had nipple partial ischemia, and 1 (1.4%) had total nipple necrosis. The mean follow-up was 11.4 ± 6.2 months; only 1 patient showed recurrence.
Conclusion:
Robotic breast surgery is a feasible method with good cosmetic outcome under suitable patient selection. Oncologic safety is not a reason to stop its development.
Insights
Robotic nipple sparing mastectomy (R-NSM) is a feasible breast cancer treatment with good cosmetic outcomes. The surgeon
Area of Science:
- Minimally invasive surgery
- Surgical oncology
- Breast cancer treatment
Background:
- Preliminary results of robotic nipple sparing mastectomy (R-NSM) for breast cancer patients.
- Analysis of a single surgeon's learning curve for R-NSM at one medical center.
Purpose of the Study:
- To evaluate the feasibility and outcomes of R-NSM.
- To analyze the learning curve associated with R-NSM procedures.
Main Methods:
- Retrospective review of 78 breast cancer patients undergoing R-NSM (2018-2020).
- Analysis of clinical and pathological tumor characteristics.
- Learning curve assessment using cumulative sum (CUSUM) analysis.
Main Results:
- Significant reductions in mastectomy, reconstruction, and total operation times observed around the 22nd-26th procedures.
- Patient factors like body weight and specimen weight correlated with mastectomy time.
- Low rates of nipple complications (5.6% partial ischemia, 1.4% total necrosis) and one recurrence observed during follow-up.
Conclusions:
- Robotic breast surgery, including R-NSM, is a viable option with satisfactory cosmetic results.
- Oncologic safety supports the continued development of robotic techniques in breast cancer surgery.
