Minimally invasive versus conventional nipple-sparing mastectomy: BREAST-Q outcomes from a pilot study

Background Minimally invasive nipple-sparing mastectomy (NSM), including robotic-assisted (RNSM) and endoscopic (ENSM) techniques, aims to improve quality-of-life while maintaining oncologic safety. Comparative evidence using validated patient-reported outcomes (PROs) remains limited. Methods We performed a retrospective analysis of a prospectively maintained database of 40 women who underwent NSM with immediate subpectoral direct-to-implant reconstruction between 2023 and 2025 (RNSM n = 10, ENSM n = 10, conventional NSM [CNSM] n = 20). PROs were assessed at 3 and 6 months using BREAST-Q version 2.0. The primary endpoint was satisfaction with breasts at 6 months. Secondary outcomes included psychosocial well-being, physical well-being: chest, sexual well-being, impact on work, postoperative complications, and permanent margin status. Results At 6 months, satisfaction with breasts differed across groups (RNSM, 86.0 ± 3.7; ENSM, 84.6 ± 3.8; CNSM, 80.5 ± 4.7; p = 0.004). Differences were also observed for psychosocial well-being (p = 0.001), physical well-being: chest (p = 0.005), and sexual well-being (p = 0.014). Tukey-adjusted pairwise comparisons showed no significant differences between ENSM and RNSM in any BREAST-Q domain at either 3 or 6 months (all adjusted p > 0.05). Complication rates did not differ significantly (p = 0.530), and all permanent tumor margins were negative. CNSM scores improved over time but remained lower than those of the minimally invasive groups. Conclusion In this pilot study, minimally invasive NSM may be associated with higher 6-month BREAST-Q scores than CNSM. These preliminary findings require confirmation in larger prospective studies incorporating preoperative and longitudinal BREAST-Q assessment. No statistically significant difference in early complications was detected, although the study was not powered for safety comparisons.