Robotic Assisted Versus Conventional Open Nipple Sparing Mastectomy With Implant Based Reconstruction for Breast...

Robotic assisted nipple sparing mastectomy (RNSM) has been increasingly adopted for therapeutic breast cancer surgery. However, comparative evidence regarding oncologic outcomes and surgical safety relative to conventional open nipple sparing mastectomy (CNSM) remains limited. A systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched for studies reporting outcomes of RNSM and/or CNSM with implant based reconstruction for invasive breast cancer or ductal carcinoma in situ. Both comparative studies and single arm robotic series were included. Prophylactic mastectomies were excluded. Primary outcomes were locoregional recurrence and disease free survival (DFS). Clinical characteristics, follow up duration, and surgical complications were descriptively summarized. Of 63 identified studies, 7 met inclusion criteria, comprising comparative cohorts and single arm robotic series. Patients were predominantly middle aged, with early stage disease, small tumor size, hormone receptor positive tumors, and low prevalence of smoking and major comorbidities. Median or mean follow up ranged from approximately 6 to 36 months. Compared with CNSM, RNSM was associated with longer operative time but lower intraoperative blood loss. Overall complication rates ranged from 0% to approximately 30%, with infrequent major complications. Rates of nipple areolar complex necrosis, skin necrosis, infection, seroma, hematoma, and implant loss were comparable between approaches. Locoregional recurrence was uncommon, ranging from 0% to approximately 2%, and no meaningful differences in DFS were observed across comparative studies. Single arm robotic series demonstrated similarly low recurrence rates and acceptable safety profiles during available follow up. This systematic review suggests that RNSM with implant based reconstruction provides oncologic and surgical outcomes comparable to CNSM in selected breast cancer patients. While short to mid term recurrence and complication rates are low, longer follow up and prospective studies are required to confirm long term oncologic safety.