A case series of robotic nipple‐sparing mastectomy with implant reconstruction in mutation carriers

Abstract Objective To evaluate the safety, feasibility and outcomes of robotic‐assisted nipple‐sparing mastectomy (RNSM) with immediate implant reconstruction in women carrying hereditary breast cancer–associated mutations. Methodology Between August 2019 and July 2025, women with germline BRCA1 , BRCA2 or TP53 mutations and low perioperative risk were prospectively recruited for RNSM followed by immediate implant‐based reconstruction. Exclusion criteria included obesity, diabetes, heavy smoking and significant breast ptosis. All operations were performed using the da Vinci Xi robotic system. Operative details, perioperative morbidity and reconstructive outcomes were recorded and analysed descriptively. Results Seven women underwent a total of 11 RNSMs. Median age at surgery was 38 years. Reconstruction used either subpectoral or prepectoral implants (200–475 cc). Median operative time was 215 minutes, with minimal blood loss and no conversions. Complications comprised one implant loss due to skin necrosis, one partial nipple–areolar complex necrosis requiring debridement and two transient nipple–areolar complex ischaemic events. No infections or haematomas occurred. Conclusions RNSM with immediate implant reconstruction is safe and feasible for selected genetic mutation carriers. As the first reported Hong Kong series, this study expands regional data and supports the robotic approach as a minimally invasive option for mastectomy.