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Minimally invasive nipple-sparing mastectomy reduces surgical trauma and postoperative complications in breast cancer patientsMinimally invasive surgery may reduce complications after breast cancer surgery

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Key Takeaway
Consider minimally invasive nipple-sparing mastectomy to reduce surgical trauma and postoperative complications.

This meta-analysis compares minimally invasive nipple-sparing mastectomy (including robotic-assisted and endoscopic-assisted approaches) to conventional open nipple-sparing mastectomy for patients with breast cancer. The analysis focuses on perioperative outcomes, postoperative complications, aesthetic-related outcomes, and oncologic outcomes.

Findings indicate that the minimally invasive group experienced longer operative times but demonstrated lower rates of blood loss, shorter incision lengths, and shorter reconstruction times compared to the conventional approach. Furthermore, the minimally invasive group showed lower rates of overall complications, skin necrosis, seroma, and hematoma or bleeding. No significant differences were observed regarding delayed wound healing, nipple-areola complex complications, nipple necrosis, flap necrosis, or recurrence.

The authors note that evidence regarding long-term oncologic outcomes, recurrence, and patient-reported aesthetic benefits is limited. Clinically, minimally invasive NSM may offer advantages in selected perioperative outcomes, including reduced surgical trauma and postoperative complications, though these findings do not currently confirm improvements in long-term oncologic safety or subjective aesthetic outcomes.

How this fits prior evidence

This meta-analysis addresses a gap in surgical technique comparison for breast cancer management. While other evidence focuses on systemic treatments, such as the impact of exercise on chemotherapy response or the role of sTIL levels in HER2 positive breast cancer, this study specifically evaluates the perioperative benefits of minimally invasive surgical techniques. It provides evidence on surgical outcomes but does not address the oncologic outcomes or aesthetic benefits that are currently limited in the literature.

When facing breast cancer, the choice of surgical technique is a major decision. Patients undergoing a nipple-sparing mastectomy often weigh the importance of surgical precision against the risk of complications. Recent data suggests that using minimally invasive methods, such as robotic-assisted or endoscopic-assisted approaches, may offer specific benefits during the recovery phase.

The analysis compared these minimally invasive techniques to conventional open surgery. The findings showed that patients who underwent minimally invasive procedures experienced less blood loss, shorter incision lengths, and shorter reconstruction times. Importantly, these patients also saw lower rates of common complications like skin necrosis (tissue death), seroma (fluid buildup), and hematoma (blood collection). While these surgeries took longer to perform, they resulted in fewer overall complications.

It is important to note that while the immediate surgical outcomes were promising, the evidence is still limited in other areas. The data did not show significant differences in wound healing, nipple-areola complications, or cancer recurrence. Because long-term aesthetic benefits and long-term cancer outcomes are not fully established, patients should discuss these specific surgical trade-offs with their surgical team.

What this means for you:
Minimally invasive breast surgery can reduce blood loss and common complications like skin death or fluid buildup.

Common questions

What are the benefits of minimally invasive surgery for breast cancer?

Minimally invasive techniques, including robotic-assisted and endoscopic-assisted approaches, can lead to less blood loss, shorter incision lengths, and shorter reconstruction times. These methods also showed lower rates of overall complications, skin necrosis, seroma, and hematoma or bleeding compared to conventional open surgery.

Are there any risks or downsides to the minimally invasive approach?

While the minimally invasive approach resulted in fewer complications and less blood loss, the surgery did take a longer time to perform. However, there were no significant differences found regarding delayed wound healing or complications specifically involving the nipple-areola complex.

Does this surgery affect cancer recurrence or long-term results?

The data showed no significant difference in cancer recurrence between the two methods. However, because the evidence is currently limited regarding long-term oncologic outcomes and patient-reported aesthetic benefits, you should talk to your doctor about your specific goals.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
To compare perioperative outcomes, postoperative complications, aesthetic-related outcomes, and oncologic outcomes between minimally invasive nipple-sparing mastectomy (NSM), including robotic-assisted and endoscopic-assisted approaches, and conventional open NSM in patients with breast cancer. Studies comparing minimally invasive and open nipple-sparing mastectomy were searched in PubMed, Embase, Web of Science, and the Cochrane Library. Data on operative outcomes, complications, cosmetic-related indicators, and recurrence were extracted and pooled. Twelve studies were analyzed. Minimally invasive surgery required a longer operative time but was associated with less blood loss, shorter incisions, and shorter reconstruction time. It also showed lower rates of overall complications, skin necrosis, seroma, and hematoma or bleeding. Delayed wound healing, nipple-areola complex complications, nipple necrosis, flap necrosis, and recurrence did not differ significantly between the two groups. Minimally invasive NSM may offer advantages in selected perioperative outcomes, including reduced surgical trauma and postoperative complications. However, evidence regarding long-term oncologic outcomes, recurrence, and patient-reported aesthetic benefits remains limited and requires further validation.
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