The first robotic-assisted nipple-sparing mastectomies, a technique that only recently received FDA approval in the United States, have been successfully performed at UF Health by Lisa Spiguel, M.D., a professor in the University of Florida Department of Surgery’s Division of Surgical Oncology.
Although nipple sparing mastectomies — a procedure preserving the entire skin envelope at the time of removing all or most tissue of the breast to treat or prevent cancer — have been performed for decades, the use of robotic assistance was only approved in the U.S. this past December after an analysis of clinical data demonstrated equivalent oncologic outcomes for patients undergoing robotic assistance, with overall improved quality of life as compared to traditional techniques.
“This data is what drove us here at the University of Florida,” Spiguel said.
Patients who receive other forms of mastectomies commonly have little-to-no sensation in their skin following the procedure, but published studies show up to 90% of patients who receive this new kind of procedure retain some skin sensation.
For Spiguel, this combination of leading-edge technology and improved patient outcomes was the perfect opportunity to expand the scope of her practice. UF Health is already home to some of the most advanced surgical robots in the world, and she embarked on months of training to learn how to use them to perform this new procedure.
Spiguel, who was already performing several nipple-sparing mastectomies a month, said the opportunity to leverage the new technology is exciting.
“A lot of my research and clinical interests revolve around improving quality of care,” said Spiguel, section chief of breast surgery in the department’s oncologic service. “How do we do what we do better? How do we improve long-term quality of life for patients?”
Spiguel said shared decision making is an important part of the process in her specialty.
“Patient conversations play an important role, and these conversations can be a little different than in other surgical services,” she said. “We always focus on determining the correct, individualized approach for cancer prevention and cure while also bearing in mind each patient’s overall goals.”
Cecila Hampson, M.S., PA-C, a physician assistant in the department who was integral in getting the program off the ground at UF, attended the same trainings with Spiguel and has worked side-by-side with her for nearly five years in the operating room.
She agreed that the patient experience is a huge piece of the treatment puzzle.
“I think our surgical service is very good about understanding that we’re not just treating a problem,” Hampson said. “We’re treating a human being with loved ones and a rich life outside of their diagnosis.”
Years of well-practiced teamwork have allowed them to successfully bring robotic-assisted nipple sparing mastectomies to the forefront at UF Health.
“Our first robotic-assisted procedure was really excellent,” she said. “I know how she moves and she knows how I move, and that understanding made for a very seamless experience — for us but also for the patient and the rest of the team.”
Hampson and Spiguel both credit UF for providing essential support and creating an environment that opens the door for innovation and growth.
“I’m going on my 15th year as a faculty member at UF,” said Spiguel, who was promoted to full professor last year. “One of the reasons I truly love it here is because they support us in the programmatic growth we believe in. When I told the university and the Department of Surgery that this was the next best step for our patients, they listened and they helped me pioneer it.”
Hampson said that support has been very gratifying.
“We’re not just part of this institution,” she said. “We’re bringing something new to the institution and showing them that we can fearlessly look at the future and what is possible. The University of Florida gives us the room and the resources to do that for our patients.”
