Abstract
Objective: To preliminarily evaluate the feasibility, safety, and early aesthetic outcomes of using the pectoralis major fascia in robotic nipple-sparing mastectomy with immediate breast reconstruction with gel implant (RNSMIBR). Methods: This study was a retrospective cohort study. From November 2023 to April 2025, 34 female breast cancer patients who met the inclusion criteria were treated at the First Affiliated Hospital of Zhengzhou University. Seventeen patients, aged 43±7 years, who underwent posterior subpectoral pocket expansion using a titanium mesh patch in RNSMIBR surgery were included into titanium mesh patch group, and 17 patients, aged 46±7 years, who underwent posterior subpectoral pocket expansion using the pectoralis major fascia in RNSMIBR surgery were included into pectoralis major fascia group. Surgery-related complications during postoperative hospitalization and follow-up within 30 days after discharge were recorded and graded using the Clavien-Dindo classification. During the follow-up of approximately 3 months postoperatively, the BREAST-Q scale was used to score the patients' satisfaction with breast appearance, psychosocial well-being, and satisfaction with medical care. Results: During postoperative hospitalization and follow-up within 30 days after discharge, three patients in titanium mesh patch group experienced grade Ⅰ complications. In pectoralis major fascia group, three patients experienced grade Ⅰ complications and three patients experienced grade Ⅲb complications. The grade Ⅲb complication in one patient was caused by radiotherapy. No complications occurred in other patients in the two groups. There was no statistically significant difference in the Clavien-Dindo classification of surgery-related complications between the two groups of patients (P>0.05). During the follow-up of approximately 3 months postoperatively, the BREAST-Q scale scores were 92±5 in titanium mesh patch group of patients and 79±28 in pectoralis major fascia group of patients, with no statistically significant difference between the two groups (P>0.05). Conclusions: The pectoralis major fascia-assisted expansion technique may serve as an alternative option of expansion in RNSMIBR when titanium mesh patch is unavailable or cost-prohibitive. For patients requiring postoperative radiotherapy, titanium mesh patch or other materials that do not rely on vascular supply are still preferred to balance aesthetic outcomes and complication control.