Minimally Invasive Nipple-Sparing Mastectomy: Early Experience With Endoscopic and Robotic Techniques

Minimally invasive nipple-sparing mastectomy (NSM), performed via endoscopic or robotic-assisted approaches, has been developed to improve cosmetic and psychosocial outcomes without compromising oncologic safety. While international experience is growing, data from low- and middle-income countries remain limited.

We conducted a retrospective case series of five consecutive patients (six breasts) who underwent minimally invasive NSM between January 2024 and June 2025 in an Indian center. Three patients underwent conventional endoscopic NSM and two underwent robotic-assisted NSM (one unilateral and one bilateral). Data collected included demographic and genetic status, tumor biology, operative details, reconstruction method, perioperative complications, pathology, and short-term follow-up. Primary endpoints were feasibility and safety; secondary endpoints were margin status, early oncologic outcomes, and cosmetic satisfaction.

All procedures were completed successfully without conversion to open surgery. Median (range) operative time was 210 (180-300) minutes, with robotic procedures requiring longer duration. No intraoperative complications, nipple-areolar necrosis, or implant losses were observed. Two patients developed minor seromas that resolved with aspiration. Pathological margins were negative in all cases. At a median follow-up of six (4-18) months, all patients were alive, disease-free, and reported good-to-excellent cosmetic satisfaction.

Our early experience demonstrates that both endoscopic and robotic-assisted NSM are feasible and safe in carefully selected patients, providing satisfactory oncologic and esthetic outcomes. However, these results should be interpreted with caution due to the very small sample size, short follow-up, and absence of a comparator group. Larger prospective multicenter studies with long-term outcomes are required to confirm oncologic safety and define the role of minimally invasive NSM India.