Luminal B-like lobular breast cancer: robotic-assisted nipple-sparing mastectomy with 12-month disease-free follow-up

What happened, in summary

This 48-year-old woman had no relevant medical history when routine screening identified multiple suspicious lesions in her left breast. MRI showed 3 irregular nodules with spiculated margins, measuring 10 × 16 mm, 15 × 12 mm, and 14 × 11 mm, located at different distances from the nipple. Histopathology confirmed infiltrating lobular carcinoma with a luminal B-like profile: ER 90%, PR 100%, HER2-negative, and Ki-67 of 20%. After multidisciplinary review, she received 6 cycles of neoadjuvant taxane-based chemotherapy and had a favorable clinical and radiologic response. Even after response, the distribution of residual lesions compared with breast volume was not suitable for breast-conserving surgery. She therefore underwent a minimally invasive single-port endoscopic nipple-sparing mastectomy assisted by a SOLOASSIST II robotic arm. Surgery used a 3 cm axillary incision, CO2 insufflation, dissection of the breast gland through the small incision, and tissue sampling from behind the nipple for intraoperative assessment. Sentinel lymph node identification was performed with patent blue dye and technetium-99m. Immediate reconstruction used a prepectoral pocket and implant placed with a no-touch funnel technique. The procedure lasted 135 minutes, estimated blood loss was 210 cc, and she was discharged 24 hours later without complications. Final pathology showed residual carcinoma measuring 9 × 5 mm in the R5 lesion. At 1 and 3 months, patient-reported outcome scoring showed high procedure satisfaction. As of November 2025, she remained disease-free at 12 months. The operation also preserved the nipple-areolar complex, used careful flap assessment before implant placement, and avoided the common early complications described for breast surgery, including hematoma, infection, dehiscence, and necrosis.