SRS130 - Sensory preservation after robotic mastectomy: correlation of clinical data with cadaveric anatomical dissection

Introduction Robotic mastectomy (RM) is a novel technique that may improve preservation of skin and nipple–areolar complex sensation compared with conventional open surgery. We hypothesise that this is due to the small lateral incision performed in RM that differs from traditional methods. Methods We prospectively evaluated nine patients undergoing robotic mastectomy with immediate reconstruction. Objective sensory testing was performed using graded stimuli across four thresholds (300, 4, 0.4, 0.07 Hz) at three and six months postoperatively. To correlate clinical findings with anatomical pathways, cadaveric dissections of four breasts were performed. Results Cadaveric analysis demonstrated that the lateral intercostal nerves traversed the parenchyma of the breast and were necessarily divided during mastectomy. In contrast, medial intercostal nerves were found to course superficially, immediately deep to the dermis, allowing potential preservation during robotic surgery. Clinically, preservation of medial breast skin sensation at three months was observed in 7 of 9 patients, whereas all patients demonstrated complete loss of sensation in the lateral breast. Conclusions In contrast to traditional open mastectomy, RM permits preservation of medial breast skin sensation due to the superficial course of medial intercostal nerves. Preservation of lateral breast sensation is not possible for anatomical reasons as the lateral intercostal nerves are unavoidable during mastectomy.