Nipple preservation rates of robot-assisted nipple-sparing mastectomy for breast cancer patients with different tumor-to-nipple distance categories

BACKGROUND: Nipple-sparing mastectomy (NSM) offers aesthetic and psychological benefits for breast cancer patients but traditionally requires an adequate tumor-to-nipple distance (TND). Robot-assisted NSM (R-NSM) may facilitate controlled dissection under the nipple-areolar complex (NAC). This study evaluated the rates of NAC preservation and local recurrence in R-NSM patients across different TND ranges. METHODS: A retrospective study involving 173 patients who underwent 180 R-NSMs using multi-armed surgical robots was conducted. Patients were categorized into three groups based on their TND: group A (2 cm). The nipple preservation rate, nipple necrosis rate, and local recurrence rate were compared. RESULTS: 173 patients underwent R-NSMs (n = 180) with immediate breast reconstruction, including 106 free flaps (58.9%), 54 implants (30.0%), and 20 tissue expanders (11.1%). Seven of them underwent bilateral mastectomies. The R-NSM numbers were 40 (22.2%) in group A, 72 (40.0%) in group B, and 68 (37.8%) in group C. There were 5 (2.8%) immediate nipple resections and 2 (1.11%) delayed nipple excisions. The NAC preservation rates in groups A, B, and C were 85%, 98.5%, and 98.5%, respectively (p = 0.003). During a median follow-up of 36.6 months (3.12-82.33 months), the overall NAC recurrence rate was 1.2% among patients who underwent nipple preservation. The locoregional recurrence rate was 2.8%. None of them occurred in the TND group A. Superficial nipple necrosis was noted in 23.3% of the patients, with 98.8% healed spontaneously. CONCLUSION: The nipple preservation rate with TND