Comment on: “Robotic and Endoscopic Minimally Invasive Breast Surgery: A Narrative Synthesis on Divergent Global Adoption and Emerging Trends”

We read with great interest the narrative synthesis by Vidya et al.(1) on divergent global adoption patterns in minimally invasive breast surgery (MIBS).Their review is both timely and important, as it shifts the discussion beyond feasibility, safety, and oncologic non-inferiority toward a more clinically relevant question: how minimally invasive nipple-sparing mastectomy (NSM) can be disseminated effectively across different healthcare systems.The authors demonstrate that minimally invasive mastectomy is not a single entity but a family of procedures shaped by infrastructure, training, the integration of reconstruction, cost, and institutional priorities.This classification provides a valuable framework for understanding robotic and endoscopic NSM as context-dependent solutions.A particularly insightful aspect is the contrast between roboticsdriven adoption in high-income countries and endoscopic innovation at scale in upper-middle-income settings.Robotic NSM, while enabled by advanced platforms and institutional investment, remains resource-intensive and concentrated in specialized centers.In contrast, endoscopic NSM represents a more scalable and cost-conscious solution adaptable to high procedural volumes.