Nipple-sparing mastectomy with immediate implant reconstruction: a comparative study
A systematic review and meta-analysis evaluates three techniques for nipple-sparing mastectomy (NSM) with immediate prosthetic breast reconstruction (IPBR). Drawing on ten studies (1,525 patients), it compares conventional, robotic, and endoscopic-assisted approaches and summarizes the advantages and limitations of each.
Breast cancer remains one of the most common cancers globally, and NSM—preserving the nipple-areola complex (NAC) while removing cancerous tissue—has emerged as a promising solution to minimize visible scarring and maintain quality of life for patients. However, significant challenges remain in optimizing surgical techniques for the best oncological and cosmetic outcomes. This new study provides a head-to-head comparison of three major approaches to NSM: conventional NSM (CNSM), endoscopic-assisted NSM (ENSM), and robotic NSM (RNSM).
Key Findings
- Incision Length and Cosmetic Outcomes
The study found that ENSM achieved the shortest scars, reducing incision length by an average of 5.6 cm compared to CNSM. RNSM also demonstrated a trend toward shorter incisions, though it did not reach statistical significance. This positions ENSM as the optimal choice for patients prioritizing aesthetic results.
- Surgical Efficiency and Operating Time
CNSM emerged as the most time-efficient approach, offering a quicker procedure and lower initial cost. However, ENSM and RNSM required approximately an additional hour of surgery due to their more complex techniques.
- Complication Rates and Cancer Control
In terms of complications, RNSM demonstrated the most promising outcomes. It reduced overall complications by 27% compared to CNSM and showed a remarkable 63% reduction in severe complications. Importantly, RNSM nearly eliminated NAC necrosis, a common and serious complication. Furthermore, RNSM showed the lowest cancer recurrence rates, with a 94% reduction in recurrence compared to CNSM. ENSM also showed improved safety outcomes but still fell behind RNSM in minimizing complications.
- Blood Loss and Hospital Stay
All three techniques showed similar blood loss and hospital stay durations. RNSM had the edge in minimizing intraoperative bleeding, while CNSM resulted in slightly shorter hospital stays.
Practical Implications for Clinicians and Patients
Choosing the appropriate technique depends on various factors, including patient preferences, available resources, and clinical priorities. CNSM is a reliable and cost-effective option, ideal for settings with limited resources or expertise. ENSM offers the best cosmetic outcomes, making it a suitable choice for patients who prioritize aesthetics and are willing to accept a longer surgical time. However, for high-risk patients who require the best safety outcomes, RNSM stands out, providing superior complication control and cancer recurrence prevention.
Despite the higher upfront costs and technical requirements of robotic surgery, RNSM may lead to long-term savings due to its reduced complication rates. Health systems should weigh the cost of equipment and training against the potential for improved patient outcomes and reduced healthcare costs in the long run.
Looking Ahead: Future Research Directions
The study authors emphasize the need for larger, multicenter randomized trials to validate these findings and explore the long-term benefits of minimally invasive NSM approaches. Future research should focus on standardizing reporting methods and further investigating the influence of implant placement and adjuvant therapies on patient outcomes.
Conclusion: Toward Personalized Care in Breast Cancer Surgery
This study highlights the transformative potential of minimally invasive NSM techniques in breast cancer surgery. By tailoring treatment choices to individual patient needs—whether they prioritize cosmetic outcomes, safety, or efficiency—clinicians can offer truly personalized care. While CNSM remains an effective, widely accessible option, ENSM and RNSM provide opportunities for enhanced outcomes, depending on patient priorities.
Ongoing research will play a critical role in refining these techniques and ensuring broader access to the most effective and personalized treatments for patients with breast cancer.
More information:
Na An et al, Comparison of robotic, conventional, and endoscopic nipple-sparing mastectomy with immediate prosthetic breast reconstruction for breast cancer: A systematic review and meta-analysis. Biomol Biomed [Internet]. 2025 Apr. 21 [cited 2025 Nov. 6];25(8):1737–1750.
Available from: https://doi.org/10.17305/bb.2025.11687
Journal information: Biomolecules and Biomedicine
Provided by: Association of Basic Medical Sciences of FBIH
Provided by Association of Basic Medical Sciences of FBIH
