Single-port robot-assisted nipple-sparing mastectomy: a systematic review

Single-port robot-assisted nipple-sparing mastectomy (SPRNSM) has emerged as an innovative minimally invasive alternative to conventional and multi-port robotic techniques, aiming to improve cosmetic outcomes while maintaining oncologic safety. This systematic review evaluates the feasibility, safety, and current evidence supporting SPRNSM. A systematic search of PubMed, the Cochrane Library, and ClinicalTrials.gov was conducted from database inception to July 4, 2026. Studies involving adult women undergoing SPRNSM for therapeutic or prophylactic indications were included. Both clinical and cadaveric studies reporting relevant outcomes were eligible. Study selection and data extraction were performed independently by two reviewers. Risk of bias was appraised using the ROBINS-I tool. Due to heterogeneity, results were synthesized narratively. Sixteen studies were included, comprising seven retrospective studies, one prospective study, five case reports, two case series, and one cadaveric study. SPRNSM was technically feasible across all studies, with no reported conversions to conventional surgery. Operative times were significantly longer than conventional nipple-sparing mastectomy (mean differences of 54-70 min) but comparable to multi-port robotic approaches. Grade III or higher complications ranged from 1.8% to 20%, with reoperation rates from 1.4% to 7.5%. Nipple-areolar complex necrosis rates were consistently low (1.2%-2.5%) and patient-reported satisfaction and sensory preservation were favorable. Short-term oncological outcomes appeared comparable to conventional techniques, although follow-up was limited to a maximum of 36 months. Overall risk of bias was serious for 80% of clinical studies. Current evidence suggests that SPRNSM is a feasible and safe procedure with potential cosmetic and functional advantages. However, the evidence base is limited by predominantly retrospective designs, small sample sizes, selection bias toward high-volume centers, and short follow-up, preventing definitive conclusions regarding long-term oncologic safety. SPRNSM represents a promising evolution in minimally invasive breast surgery; however, until long-term oncologic data become available, its use should remain limited to controlled settings and prospective trials. Ongoing randomized trials are expected to provide higher-level evidence in the coming years.