MINIMALLY invasive endoscopic or robotic techniques delivers broadly comparable surgical and patient-reported outcomes in single-incision approach to nipple-sparing mastectomy (NSM), with only modest differences depending on incision placement, according to a large retrospective study.
Large 13-Year Study Compares Two Single-Incision Approaches in 371 Mastectomies
Research examined 371 cases of minimal access nipple-sparing mastectomy performed at a single institution over a 13-year period, comparing two commonly used single axillary incision strategies: placement within the axillary crease or along the lateral chest wall. Both approaches are increasingly used in endoscopic and robotic-assisted breast surgery to improve cosmetic outcomes while maintaining oncological safety.
Overall, both incision types demonstrated similar rates of post-operative complications, oncological safety measures, and patient-reported satisfaction. Rates of nipple preservation, margin involvement, and sensory outcomes were broadly equivalent between the two groups, supporting the continued use of either approach in appropriately selected patients.
Small Technical Differences Seen in Operative Time and Wound Healing
Differences emerged in specific perioperative and wound-related outcomes. In endoscopic procedures, the lateral chest wall incision was associated with shorter operative times compared with the axillary crease approach, suggesting improved instrument access and efficiency. This difference was not observed in robotic-assisted procedures, where operative times were similar regardless of incision site.
Post-operative complications were generally low across both groups, but delayed wound healing occurred more frequently in patients receiving a lateral chest wall incision. Researchers suggest this may relate to increased skin tension and greater mechanical stress in this anatomical region during shoulder movement.
Patient Satisfaction and Sensory Outcomes Remain Equivalent Across Both Techniques
Patient-reported outcomes showed no significant differences between axillary crease and lateral chest wall incision approaches, including satisfaction with breast appearance, scar position, and physical, psychosocial, and sexual well-being. Most patients in both groups said they would choose the same procedure again.
Post-operative sensory recovery of the nipple–areolar complex and surrounding breast tissue was also comparable, suggesting incision placement does not materially affect sensation outcomes.
The authors conclude that both techniques achieve similar oncological, functional, and patient-centred results, with choice of incision likely best guided by surgical approach, experience, and anatomical factors rather than differences in effectiveness or patient satisfaction.
Reference
Koh CH et al. Single axillary incision for minimal access (endoscopic or robotic-assisted) nipple-sparing mastectomy: axillary crease or lateral chest wall incision? J Robot Surg. 2026;20:553.
Featured Image: misu on Adobe Stock
