Innovation is a hallmark of academic medical centers, where the latest technologies and scientific discoveries are translated into new treatments and procedures to improve patient care.
At UT Southwestern Medical Center, Deborah Farr, M.D., Associate Professor of Surgery, had an idea in 2018 for using robotic surgery to perform mastectomies for breast cancer patients, in hopes that a minimally invasive approach would provide a better physical result for women.
Collaborating with Nicholas Haddock, M.D., Professor of Plastic Surgery and Orthopaedic Surgery, she developed a first-of-its-kind robotic nipple-sparing mastectomy (rNSM) and reconstruction procedure that provides remarkably natural-looking outcomes while preserving full sensation in the breast.
Dr. Farr said the journey to bring the advanced procedure to patients in North Texas was “marked by curiosity, stubbornness and a little luck.” At the time, the U.S. Food and Drug Administration (FDA) and others were raising concerns around the safety of robotic breast surgery. But with the support of UT Southwestern, Drs. Farr and Haddock pressed ahead.
UTSW was the first hospital in the U.S. to perform a single-port robotic nipple-sparing mastectomy and profunda artery perforator (PAP) flap reconstruction. In January 2024, the physicians published the results of a four-year study showing that the procedure is not only a safe and feasible approach to breast reconstruction – it also gives patients a very good chance of retaining some or all of the sensitivity in their breasts.
Rather than making incisions in the underwire area below the breasts, the procedure uses a single-port robot to enter the breast from the armpit to remove tissue and reconstruct the breast, avoiding the nerve damage that results in desensitization. The treatment removes patients’ cancer without some of the disheartening long-term side effects of a traditional mastectomy.
Robot-assisted procedures require two providers – one at the bedside and one controlling the robot from a console in the operating room. For the early rNSM clinical trials, Dr. Farr operated the robot while Herbert Zeh III, M.D., Chair and Professor of UTSW’s Department of Surgery, was at bedside, helping articulate the borders of the breast tissue. After several surgeries, he taught a physician assistant to serve in this role.
Several cases into their initial study, Dr. Farr said, the physicians noticed a surprising trend: Every patient had retained sensitivity in their breasts. Women were reporting “hyper-sensation” and full sexual function in follow-up, saying they could feel soft touch as well as pressure in the nipple and breast.
“Dr. Haddock and I were floored,” Dr. Farr said. “In a traditional mastectomy, the breast tissue and nerves are often stretched and potentially severed from the incisions and manipulation of the tissue. Even if the reconstructed breasts looked fantastic, patients would often feel as if their breasts were numb and detached, similar to how your legs feel after getting an epidural.”
With rNSM, nerve disruption is significantly reduced. Entering through the side is much gentler, and the physicians suspect this is why their patients retained sensation. They started doing formal sensation measurements with each patient on follow-up, and every patient in the initial study maintained sensation.
Patients began spreading the word, and people in the medical community got wind of UTSW’s positive outcomes – including the FDA, which in 2021 invited Drs. Farr and Haddock to apply for an investigational device exemption (IDE). That would grant a formal license to hold a larger clinical trial, which was granted and launched in January 2022, and the results to date have been outstanding.
UT Southwestern has performed about 100 rNSM procedures, and 80% of patients have retained sensation.
“In the past, there was a ferocious approach to eradicating breast cancer at any cost to a patient’s happiness and appearance,” Dr. Farr said. “Today, our passion to save patients’ lives remains undeterred but we are also able to focus on enhancing women’s quality of life after treatment.”
Watch the video of the procedure here.