Technical refinements of the Nipple-Sparing Mastectomy with Immediate Breast Reconstruction: The Latero-Thoracic Approach Without Robotic Assistance

Summary:

Nipple-sparing mastectomy (NSM) has gained significant popularity in breast cancer surgery due to its superior aesthetic and psychological benefits compared to traditional mastectomy procedures ^1,2. Common NSM techniques involve various incision placements such as central or lateral inframammary fold, superior or inferior periareolar with or without lateral extension, or lateral/inferior radial incisions. However, these techniques often result in visible scars and pose a risk of complications like post-mastectomy skin flap necrosis or nipple-areola complex necrosis. ^1,3,4. To enhance cosmetic outcomes, robotic-assisted surgery has introduced latero-thoracic incisions, which offer improved precision, flexibility, and the ability to conceal scars ^5–8. Despite these advantages, the high costs and requirement for specialized training have limited the widespread adoption of robotic-assisted NSM.

In this study, we present an innovative refinement of the NSM technique, utilizing a latero-thoracic upper lateral mammary fold incision without the need for robotic assistance. This minimally invasive approach achieves the same aesthetic goals by concealing scars while ensuring oncological safety. It also leverages standard surgical instruments, making it more accessible and cost-effective for a broader range of surgical practices. With this technique, immediate breast reconstruction can be performed using either implant-based methods or free flap techniques, with anastomosis to the nearby circumflex scapular vessels ^9–11.

We report a technical refinement of the NSM procedure with a minimally invasive latero-thoracic incision to warrant the same aesthetic and oncological benefits as robotic-assisted methods, without the associated costs and training barriers.