Feb. 19, 2026
Mayo Clinic Comprehensive Cancer Center is expanding surgical options for patients undergoing treatment or risk-reducing procedures for breast cancer through the adoption of robotic nipple-sparing mastectomy (NSM) at its Minnesota and Florida campuses. Following recent Food and Drug Administration clearance of the use of this platform for these procedures, Mayo Clinic surgeons are now offering a minimally invasive approach. This is designed to improve cosmetic outcomes, preserve skin and nipple viability, and broaden opportunities for potential sensory restoration.
A refined approach to mastectomy and reconstruction through robotic nipple-sparing mastectomy
NSM preserves the nipple-areolar complex and healthy breast skin, creating a more natural-appearing reconstructed breast after reconstruction. The improved cosmetic result can offer meaningful psychological benefits for patients compared with a traditional mastectomy result. However, many patients continue to experience visible scarring, diminished or absent sensation in the breast and nipple, and risk of loss of nipple or skin due to low blood flow.
The robotic approach provides a way to address some of these challenges by enabling a small, lateral incision, gentle tissue retraction with gas insufflation, and enhanced visualization of the surgical field. These features support improved aesthetic outcomes and preservation of skin and nipple perfusion. In some cases, Mayo Clinic surgeons also are integrating sensory-restoring procedures, including neurotization, known as reinnervation, of the nipple-areolar complex to help patients regain protective sensation in their reconstructed breasts.
"When we remove the breast tissue and keep the envelope of the breast skin and nipple, it provides the most natural-appearing breast from a cosmetic standpoint," says Mara A. Piltin, D.O., a surgical oncologist at Mayo Clinic in Jacksonville, Florida. "The next step is to improve the process so that patients regain feeling in their breasts and are not constantly seeing scars that remind them of their cancer journey. It will positively impact their sexual health, self-image and recovery."
This approach is ideal for patients with smaller cancers located away from the nipple and skin, as well as individuals at increased risk of breast cancer who are considering prophylactic mastectomy.
Considerations for robotic nipple-sparing mastectomies are complex and include:
- Body mass index (BMI), as a higher BMI increases the risk of complications.
- Cancer location, which can dictate whether nipple preservation is appropriate.
- Comorbidities, which may limit reconstructive options.
- Cup size, with a smaller cup size being ideal for a robotic approach.
- Nipple position, which influences the viability and aesthetics of the nipple following surgery.
Reducing scars and improving recovery with robotic nipple-sparing mastectomy
This approach involves a smaller incision, positioned off the front face of the breast. Data published in the British Journal of Surgery (BJS) shows lower rates of compromised blood flow to the skin and nipple with robotic NSM compared with traditional methods.
This technique is designed to maintain healthy blood flow to the skin, supporting better healing and a more natural postoperative appearance. Because the robotic approach uses gentler retraction, data published in Annals of Surgery has shown lower rates of injury to the skin and nipple.
Looking forward to additional advances in nipple-sparing mastectomy
Mayo Clinic continues to lead in NSM innovation, consistently refining surgical techniques and expanding clinical trials to enhance patient outcomes. Jeffrey E. Johnson, M.D., a surgical oncologist at Mayo Clinic in Rochester, Minnesota, emphasizes that any step made toward helping patients feel whole after treating their breast cancer or reducing their risk is something the team hopes to achieve.
Looking ahead, Mayo Clinic is leveraging artificial intelligence and 3D modeling to further reduce complications and optimize results. Dr. Johnson explains: "At Mayo Clinic, our commitment is to provide patients with the most advanced options for nipple-sparing mastectomy — combining surgical precision with techniques that restore sensation and minimize scarring. Our goal is to ensure that more patients can benefit from innovations that support not only their physical recovery but also their emotional well-being, so every patient can move forward with confidence and hope."
For more information
Nessa A, et al. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: Meta-analysis. British Journal of Surgery (BJS). 2024;111:znad336.
Lai H-W, et al. Robotic versus conventional or endoscopic-assisted nipple-sparing mastectomy and immediate prosthesis breast reconstruction in the management of breast cancer: A prospectively designed multicenter trial comparing clinical outcomes, medical cost, and patient-reported outcomes (RCENSM-P). Annals of Surgery. 2024;279:138.
Refer a patient to Mayo Clinic.
Editorial note: This article has been updated to reflect that the robotic device has received clearance by the U.S. Food and Drug Administration for certain indications, including the use described in the article.