Preliminary evaluation of pectoralis major fascia use in robotic nipple sparing mastectomy and immediate breast reconstruction with gel implant: a retrospective comparative cohort study

摘要

OBJECTIVE: To demonstrate that the feasibility of using the da Vinci robotic XI surgical system for breast reconstruction with pectoralis major fascia instead of latissimus dorsi flaps. METHODS: A retrospective analysis was conducted on the clinical data of 33 female patients with breast cancer who were treated with robotic nipple sparing mastectomy and immediate breast reconstruction with gel implant (RNSMIBR) between September 2022 and June 2024 and met the selection criteria. The surgical techniques employed included the use of a latissimus dorsi muscle flap (LDMF) in seven cases (Group A), a LDMF without skin island in nine cases (Group B) and a pectoralis major fascia in 17 cases (Group C). The following data recorded: age, indication, body mass index, pathological type, treatment plan, operative time, complications, and postoperative aesthetic results. RESULTS: The time for unilateral RNSMIBR was (288.57 ± 108.68) minutes in group A, (272.22 ± 39.38) minutes in group B, and (88.53 ± 14.93) minutes in group C. In Group C, three patients erythematous flaps, and three patients experienced implant loss due to infection. The remaining patients expressed satisfaction with the aesthetic outcome of the procedure. CONCLUSIONS: The utilization of the pectoralis major fascia in lieu of the latissimus dorsi flap for RNSMIBR results in superior aesthetic outcomes and circumvents the potential injury to muscle tissue. Nevertheless, further investigation is required to ascertain the safety of this approach.