Summary Listen
- Dr. Thumsi discusses robotic nipple-sparing mastectomy as a precision, preservation, and progress approach to breast cancer surgery, emphasizing its significance in the context of rising breast cancer incidence among young Indian women. While breast cancer incidence is on the rise, improved treatments have led to a high 5-year survival rate, shifting focus to quality of life and addressing the social concerns related to femininity and body image.
- Surgical treatment options have evolved from radical mastectomies to breast conservation surgery (BCS) which is the standard of care whenever possible. BCS avoids the negative impacts of mastectomy on self-esteem and body image, and if mastectomy is necessary, skin-sparing or nipple-areolar sparing approaches with reconstruction are preferred. Different types of breast conservation surgeries are performed including scarless and bat-wing oncoplastic surgery as well as using Latissimus Dorsi (LD) flaps for larger tumors.
- Robotic nipple-sparing mastectomy is a recent advancement for patients who require mastectomy, involving the removal of breast tissue while preserving the skin, nipple, and areola. It is indicated for moderate breast sizes, risk-reduction mastectomies in BRCA mutation carriers, tumor sizes under 5 cm and more than 3mm away from the skin, and favorable tumor biology. Benefits include nipple and skin preservation, superior visualization with 3D magnification, greater instrument range of motion, small incisions, rapid recovery, reduced pain and blood loss, shorter hospital stays, and better cosmetic outcomes.
- While complication rates are similar to conventional mastectomy, robotic nipple-sparing mastectomy has a long learning curve, longer surgery times initially, and higher costs. Dr. Thumsi underwent simulator training, international training in Taiwan, and animal lab practice before performing the procedure. Titanized polypropylene mesh (Tailoop Bra) is used for reconstruction with implants due to its lower inflammation risk, better compatibility, and good aesthetic results.
- Dr. Thumsi's team began performing robotic nipple-sparing mastectomies in India in May 2024, completing 36 surgeries with an average patient age of 43. Various diagnoses and scenarios were addressed, including prophylactic mastectomies, upfront surgeries, and post-neoadjuvant chemotherapy cases. Robotic nipple-sparing mastectomy is a feasible approach associated with improved quality of life and patient satisfaction. However, concerns remain regarding increased operative time, the need for specialized skills, and the long-term oncological safety of the procedure, necessitating further research.
- The importance of specialized breast units over general surgery units is highlighted, referencing a Tata Memorial Hospital study. The study indicates that breast cancer surgery performed in specialized units improves survival, as general surgeons may perform incomplete surgeries, leaving residual nodes, and may deal with already metastatic cases.
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About the Speakers
Dr. Jayanti Thumsi
Group Lead - Robotic Breast Surgeon, HCG Hospital, Bangalore
Financial Disclosure
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