Comparative analysis of robotic- and endoscopic-assisted minimally invasive nipple-areola complex-sparing mastectomy for breast cancer: a meta-analysis with subgroup analyses.

To compare perioperative outcomes, postoperative complications, aesthetic-related outcomes, and oncologic outcomes between minimally invasive nipple-sparing mastectomy (NSM), including robotic-assisted and endoscopic-assisted approaches, and conventional open NSM in patients with breast cancer. Studies comparing minimally invasive and open nipple-sparing mastectomy were searched in PubMed, Embase, Web of Science, and the Cochrane Library. Data on operative outcomes, complications, cosmetic-related indicators, and recurrence were extracted and pooled. Twelve studies were analyzed. Minimally invasive surgery required a longer operative time but was associated with less blood loss, shorter incisions, and shorter reconstruction time. It also showed lower rates of overall complications, skin necrosis, seroma, and hematoma or bleeding. Delayed wound healing, nipple-areola complex complications, nipple necrosis, flap necrosis, and recurrence did not differ significantly between the two groups. Minimally invasive NSM may offer advantages in selected perioperative outcomes, including reduced surgical trauma and postoperative complications. However, evidence regarding long-term oncologic outcomes, recurrence, and patient-reported aesthetic benefits remains limited and requires further validation.