Triple-Positive Breast Cancer: Robotic Single-Incision Mastectomy & Reconstruction With No Large Scars
Dr. Sandeep Nayak • MACS Clinic, Bangalore • Robotic Nipple-Sparing Mastectomy with Immediate LD Flap Reconstruction • Early Recovery & Satisfactory Cosmetic Outcome
PATIENT DETAILS
Age: 37 Gender: Female
Medical History: Triple-positive (ER+, PR+, HER2+) carcinoma of the left breast. She completed neoadjuvant chemotherapy and HER2-targeted therapy before surgery. She is young with a B-cup breast size and had strong concerns about breast appearance and visible scarring.
CASE PRESENTATION
A 37-year-old woman presented to MACS Clinic, Bangalore, with triple-positive left breast cancer. She had already completed neoadjuvant (pre-operative) chemotherapy along with HER2-targeted therapy, and was now ready for surgery.
Conventional mastectomy with reconstruction would typically leave a long scar on the breast. If a latissimus dorsi (LD) flap is used, it also leaves a second scar on the back. For a young woman with a B-cup breast size and clear cosmetic concerns, this was a significant consideration.
After evaluation, the team recommended a robotic single-incision approach. It allows cancer removal, lymph node clearance and reconstruction to be completed through one small incision, without compromising oncological safety.
| STEP 1 | STEP 2 | STEP 3 | STEP 4 | STEP 5 | STEP 6 |
| Diagnosis | Neoadjuvant Therapy | Surgical Planning | Robotic Surgery | Rapid Recovery | Cosmetic Outcome |
| Triple-positive left breast cancer confirmed | Chemotherapy and HER2-targeted therapy completed | Robotic single-incision approach chosen for age, breast size and cosmetic goals | Nipple-sparing mastectomy, axillary clearance and LD flap reconstruction via one incision | Minimal pain, discharged on post-operative day 2 | Satisfactory result with no large breast or back scars |
DIAGNOSIS
Triple-positive carcinoma of the left breast (ER+, PR+, HER2+), treated with neoadjuvant chemotherapy and HER2-targeted therapy.
Triple-positive breast cancer expresses estrogen receptors, progesterone receptors and the HER2 protein. It generally responds well to combined hormonal and HER2-targeted treatment. Giving systemic therapy first lets the team assess the tumour’s response and often makes cosmetically focused surgery easier to plan. In this patient, the completed neoadjuvant treatment set the stage for definitive surgery.
TREATMENT
- Neoadjuvant Therapy: Chemotherapy and HER2-targeted therapy (completed)
- Robotic Nipple-Sparing Mastectomy: Through a single incision
- Axillary Lymph Node Clearance: Through the same incision
- Immediate LD Flap Reconstruction: No separate back scar
- Post-operative Care: Minimal pain, discharge on day 2
- Ongoing Oncological Follow-up: Continued systemic therapy and surveillance as per protocol
DETAILED DESCRIPTION OF TREATMENT
Given her age, B-cup breast size and cosmetic priorities, a robotic single-incision approach was chosen. Through one incision, she underwent three procedures:
1. Nipple-sparing mastectomy
The breast tissue was removed while the nipple-areola complex was preserved, helping retain natural breast shape.
2. Axillary lymph node clearance
The lymph nodes were removed for staging and local control.
3. Immediate latissimus dorsi (LD) flap reconstruction
The LD muscle flap was harvested and used to rebuild the breast in the same sitting.
The robotic platform gives magnified 3D vision and precise instrument control through a small access point. This approach avoided large scars on both the breast and the back, which are usual with conventional mastectomy and open LD flap harvest.
“For a young woman, cancer treatment shouldn’t come at the cost of her confidence. The goal is to treat the cancer completely and, wherever possible, spare her the large scars.”
Dr. Sandeep Nayak, MACS Clinic, Bangalore
POST-OPERATIVE ASSESSMENT
Recovery was smooth. The patient had minimal post-operative pain, recovered early and was discharged on the second post-operative day. The cosmetic outcome was satisfactory, with no large scars on the breast or the back
This case shows that a single-incision robotic approach can combine oncological treatment, immediate reconstruction and improved scar cosmesis in a young breast cancer patient. For women in whom appearance and body image matter as much as cure, this technique offers a thoughtful alternative to conventional surgery.
FREQUENTLY ASKED QUESTIONS
Q1. What is a robotic single-incision mastectomy?
It is a technique in which the breast tissue is removed, the axillary lymph nodes are cleared and the breast is reconstructed through one small incision, using a robotic system for magnified 3D vision and precise instrument control. It avoids the long scars of conventional open surgery.
Q2. What is a nipple-sparing mastectomy, and is it safe?
In a nipple-sparing mastectomy, the breast tissue is removed but the nipple-areola complex is preserved, which helps maintain a natural breast shape. It is suitable only for carefully selected patients, and your surgical oncologist decides this after reviewing your tumour location, size and imaging.
Q3. What is an LD (latissimus dorsi) flap reconstruction?
An LD flap uses a muscle from the upper back, along with its blood supply, to rebuild the breast using your own tissue. In this case, the flap was harvested through the same single incision, so no separate large scar was left on the back.
Q4. Who is a suitable candidate for this approach?
Candidacy depends on tumour size and location, breast size, response to prior treatment and overall health. This patient was chosen because of her young age, B-cup breast size, cosmetic concerns and completed neoadjuvant therapy. Not every patient qualifies, so a detailed evaluation by the surgical team is essential.
Q5. How long is the recovery after robotic single-incision mastectomy with reconstruction?
In this case, the patient had minimal post-operative pain and was discharged on the second post-operative day. Recovery time varies from person to person, and your surgeon will advise on wound care, activity restrictions and follow-up treatment.
CONTACT — MACS CLINIC, BANGALORE
| Surgeon: | Dr. Sandeep Nayak, Surgical Oncologist |
| Clinic: | No. 96/A/9/1, 42nd Cross, 3rd Main, 8th Block, Jayanagar, Bengaluru – 560 070 |
| Email: | support@macsclinic.com |
| Phone: | +91 9482202240 | +91 80357 40000 |
| Website: | drsandeepnayak.com | macsforcancer.com |