Oncoplastic Entirely Robot-Assisted Approach (OPERA) – Incorporating Robotic Surgery in Both Mastectomy and DIEP Flap Reconstruction

Background: Currently, breast cancer surgery involves a minimally invasive approach with the assistance of robotic technology. Robots can potentially be used for harvesting free deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction to minimize donor site morbidity. For the first time, our team applied robot-assisted surgery using the oncoplastic entirely robot-assisted approach (OPERA) for both mastectomy and free DIEP flap harvesting. Patients and Methods: A retrospective chart review identified 14 patients with unilateral breast cancer who underwent robot-assisted mastectomy and robot-assisted free DIEP flap harvesting for breast reconstruction. Patient demographics and mastectomy and flap characteristics were reviewed. Results: Eleven nipple-sparing mastectomies, one areolar-sparing mastectomy, and two skin-sparing mastectomies were performed with breast cancer stage ranging from ductal carcinoma in situ (DCIS) to the more advanced stage of T3N2aM0. The size of the mastectomies ranged from 155 to 647 grams, with an average of 376.9 grams. No mastectomy-related complications occurred. Eighteen deep inferior artery and vein pedicles were dissected with the assistance of robotic arms, and the incision length of the anterior rectus sheath (ARS) was 2.6 ± 0.9 cm. The average length of the harvested pedicle was 10.3 ± 2.2 cm. The harvested flap sizes ranged from 310 to 1213 (average: 659.3 ± 298.1) grams. All flaps were successfully transferred. With a follow-up period of 19.1 ± 15.6 months, none of the patients presented with local recurrence, distant metastasis, or late donor site morbidities. Conclusion: The OPERA approach has demonstrated feasibility in patients with suitable indications.