Robots could transform breast surgery forever
· Vox
“Wait, I can feel that?” Ami Brasure remembers thinking.
For most of us, the experience that dazzled her couldn’t be more ordinary: You’re standing around, maybe in your kitchen or living room, drinking something a little too carelessly, and before you know it, the liquid is dribbling down your chin and trickling down your chest — and you can feel it. It’s a familiar sensation (in this case, perhaps an embarrassing one). But for Brasure, a 50-year-old retail sales manager from the Washington, DC, area, it was life-affirming.
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At the time, she was recovering from a double mastectomy in the wake of a stage one breast cancer diagnosis. She vividly remembers the chill from her spilled drink as it snaked its way inside the compression garment she was wearing as part of her recovery process. The sudden dampness came as a shock — not because it was unpleasant, but because she never expected to feel anything in that area at all, certainly not so soon after surgery.
Key takeaways
- Every year, hundreds of thousands of women in the United States are diagnosed with breast cancer and undergo mastectomies that can leave them with little to no feeling in their chests.
- In December 2025, the FDA cleared the da Vinci single-port surgical system for robot-assisted breast cancer surgery, specifically nipple-sparing mastectomies.
- Some surgeons are embracing this new technology because it offers a smaller, hidden scar and a clearer view inside the breast. Some patients also report better sensation in the chest area afterward.
- But critics say that there isn’t conclusive long-term evidence yet that robotic nipple-sparing mastectomies are as good as open mastectomies at making sure the cancer doesn’t come back, even if they are technically safe to perform.
As Brasure knew, many people who get mastectomies are left with little to no feeling in their chests. That loss of sensation can affect a patient’s psychological well-being, sometimes actively alienating them from their bodies as they adjust to life after treatment.
“Every patient will have their own surgical goals. And mine was to look and feel as close as I did to how I looked and felt before I went into that operating room,” Brasure told me.
So when Dr. Lucy De La Cruz, chief of breast surgery at MedStar Georgetown University Hospital, offered Brasure the chance to be the hospital’s first patient to undergo a surgery that deployed a new robotic nipple-sparing mastectomy technique, she was enthusiastic. Especially because it was a procedure that some surgeons and studies have suggested leads to better preservation of feeling.
Using a robot to aid a mastectomy is not entirely novel — surgeons around the world have been experimenting with this technique for the past decade.
But what is new is that De La Cruz’s novel surgical plan combined several procedures into one operation. Using the da Vinci single-port robotic surgical system, she removed the breast tissue while preserving the nipples and skin. In the same operation, her team checked the lymph nodes, reconstructed the breasts with implants, and reconnected the nerve to the nipples to help restore sensation. In most robotic nipple-sparing mastectomies, the surgical incision is made along the armpit or the side of the chest. But here, De La Cruz and her team did everything through a single, 4-centimeter incision on each breast, naturally hidden under its fold. The hidden surgical scar and shorter recovery period, along with the possibility of having sensation back in her breasts post-surgery, were alluring for Brasure.
Normally, surgeons performed nipple-sparing mastectomies through more conventional “open” techniques, typically through a long incision at the bottom of the breast. It is a technically challenging operation. Breast tissue extends all the way up to the collarbone, and surgeons have to reach it through a tight space with limited visibility, relying on their hands and eyes to look and feel their way around the breast. An assistant often uses large metal retractors to lift the skin around the incision to keep the area exposed and visible.
The procedure also carries a known risk of injury to the skin and nipple, sometimes severe enough that patients can lose the nipple and surrounding skin. These challenges led some surgeons to explore whether a robot-assisted surgery could help mitigate certain risks of open nipple-sparing mastectomies. But it was only in December 2025 that the Food and Drug Administration specifically cleared the use of the da Vinci single-port machine to perform mastectomies in the United States.
And at least for Brasure, it seems to have made all the difference, helping her feel better connected to her body after a procedure that might, under other circumstances, have left her with a radically altered sense of it.
In theory, robotic nipple-sparing mastectomies sound like an amazing example of where surgical technology can take us. The American Cancer Society estimates that, in 2026, about 321,910 new cases of invasive breast cancer will be diagnosed in women. Many women opt for mastectomies not just as an active cancer treatment but also preventatively to reduce their risk, especially when they have a BRCA mutation — which indicates a very high likelihood of developing breast cancer — or a family history of the disease. A surgery with the potential to preserve more sensation, leave fewer surgical scars, and allow patients to recover more quickly promises to be a boon to women’s health.
Instead, robotic nipple-sparing mastectomies have proved extraordinarily divisive among oncological surgeons. Some, including De La Cruz, have embraced them. Others worry that the technology has gotten ahead of the evidence, especially on one of the most important measures in cancer treatment: making sure that the cancer doesn’t come back.
The case for robotic mastectomies
Maleeha Aziz, a 33-year-old deputy director at an abortion fund in the Dallas-Fort Worth area, grew up around breast cancer.
Aziz was 3 years old when her mother was first diagnosed. As a child, even though she couldn’t completely understand what was happening, she remembers her mother slowly losing her luscious, thick hair and how she could no longer pick Aziz up after the double mastectomy surgery.
It was clear that there was a family history, and Aziz felt like the cancer wasn’t skipping a single person. Her nani, or maternal grandmother, and her aunt had been diagnosed with ovarian and breast cancer, respectively. But the last straw was when her 32-year-old cousin — as close to her as a sister — received a stage three breast cancer diagnosis while she was pregnant.
Having seen the ravages of the disease firsthand and knowing from genetic testing in her early 20s that she was a BRCA carrier, Aziz ultimately decided that it would be better to get a preventative double mastectomy and reduce her cancer risk rather than live with pervasive anxiety from screening to screening.
“Preventative care is not radical. What is radical is to get cancer,” she told her family when they worried that it was an unnecessary medical intervention. A preventative mastectomy can lower the risk of breast cancer by close to 90 percent.
Aziz, like Brasure, was keen on sensation preservation. She remembered hating the numbness on her abdomen after her C-section delivery when she had her daughter, and couldn’t imagine the same around her breasts.
So in 2023, at the age of 29, Aziz opted for a preventative robotic nipple-sparing mastectomy at the University of Texas Southwestern Medical Center as part of surgical oncologist Dr. Deborah Farr’s study on the feasibility of using the da Vinci single-port machine to perform the procedure. Farr was one of the few who were approved by the FDA to research and perform the robotic nipple-sparing mastectomy before it was officially cleared in 2025. More than three years later, Aziz has no regrets about her decision, especially since she has “pretty decent sensation” in her breasts, unlike her cousin who underwent a traditional mastectomy.
Aziz isn’t alone in her desire to preserve sensation in her breasts.
Breast cancer, like all cancers, can prove to be a psychological malady as surely as it is a physical one. Body image is about much more than just appearance, said Danielle Saff, an oncological social worker at CancerCare, a nonprofit providing support and counselling for people diagnosed with cancer. Body image is also about familiarity with one’s body, connections and sensations.
Saff told me that she often encounters patients who feel guilty for caring about things like how their breasts will look or how their body will change, fearing that such considerations are trivial when their lives are on the line. But patients must be allowed to ask these questions, Saff said, because they are important to their life after treatment.
“When treatment ends, [that] doesn’t mean that one’s life goes back to quote unquote normal,” Saff said. “There’s so much adjustment that happens and so much grief throughout the process.”
Losing sensation in the breasts or nipples can also affect how some patients experience intimacy, Saff said, because the surgery can affect how they feel about their changed bodies.
But for De La Cruz, however, sensation preservation goes beyond helping patients still enjoy intimacy after mastectomies — it is also about safety. What if boiling water splashes on you while you’re cooking or you accidentally hit yourself with a curling iron while doing your hair in the bathroom, she noted by way of example. Being able to feel external stimuli like pain, heat, cold, or pressure on your body is key to protecting it.
How robotic surgery works
In a robotic mastectomy, the surgeon sits at a console a few feet away from the patient and controls every movement of the machine’s instruments with their hands. The da Vinci single-port robot, the version cleared for nipple-sparing mastectomies, has one arm that enters the body through a single small incision usually along the side of the chest or, in some cases, in the fold beneath the breast. The arm has three multi-jointed instruments at one end, which the surgeon can use to bend, grasp, and dissect breast tissue, nerves, and blood vessels much like they would with their wrists and fingers in a traditional non-robotic (“open”) surgery. Usually, a plastic surgeon is also in the operating room ready to begin reconstruction once the cancer is removed.
Because these robots also have an endoscope — a medical device with an attached light used to look inside body cavities — the interior of the breast is visible to the surgeon in great three-dimensional detail and size on a display screen outside the body. This makes it much easier for surgeons to navigate complicated tissue and nerve structures once they have been properly trained on the robot.
Aziz’s surgeon, Farr, a surgical oncologist who specialises in breast cancer at the University of Texas Southwestern Medical Center, believes that the robotic nipple-sparing mastectomy is essentially the same as the open one, but with much better control and visibility.
At UT Southwestern, she often taught doctors how to perform procedures like the open nipple-sparing mastectomy.
“It is a procedure that is technically challenging for breast surgeons, and it’s really difficult for us to teach because really the only person who can see anything is the operating surgeon,” she said, adding that it’s difficult to communicate the steps and what the trainee should be doing if they can’t see inside the body.
In a traditional mastectomy, the surgical cut is held physically open with instruments called retractors, which can cause considerable physical trauma and pressure in the area around it. By contrast, in robotic surgery, carbon dioxide gas is used to open up the space in a much gentler manner. Farr believes that reduced trauma to the skin and better visualization of structures (and hence increased ability to avoid critical nerves) in robot-assisted surgery could be the reason that some patients report more sensation after nipple-sparing mastectomies performed with the da Vinci single-port machine.
Notably, in her own patients, she did not see a difference in pain or other recovery metrics for those who opted for robotic surgery compared to those who opted for an open surgery instead. That makes sense to her because, as far as she’s concerned, she is doing the same surgery, open or robotically, just using a different tool.
Nevertheless, the enhanced three-dimensional visualization, better likelihood of preserving breast sensation, and the ability to more easily teach the operation to trainees make it worthwhile for her to continue practicing and studying robotic nipple-sparing mastectomies.
Why is the procedure so divisive?
Despite all of that — the potential for patients and the advantages for surgeons alike — robotic nipple-sparing mastectomies remain controversial.
Surgeons we spoke to who remain cautious about adopting robotic nipple-sparing mastectomies are worried about one thing in particular: No study has yet shown clinical evidence that, in the long term, the patients who have undergone robotic nipple-sparing mastectomies have the same cancer survival outcomes as compared to open nipple-sparing mastectomy patients.
Their fear appears to have a valid basis.
In the United States, robot-assisted or laparoscopic surgery began to be broadly adopted around 2006 as a minimally invasive method to perform radical hysterectomies, a surgery in which the uterus, cervix, both ovaries and fallopian tubes, and nearby tissues are removed, usually as a treatment for early-stage cancers. There was limited research at the time to show that doing it this way produced long-term survival outcomes for patients who were equivalent to open radical hysterectomies — the existing, accepted standard of care.
That belief held until a randomized controlled trial published in 2018 found that patients who underwent the minimally invasive version of the radical hysterectomy had lower rates of disease-free survival as well as overall survival. In other words, the more traditional, non-robotic approach was better for patient health in the long term. The researchers note that the study was not designed to establish what is causing this result and that it is still unclear.
While robot-assisted hysterectomies may or may not be the most appropriate analog for nipple-sparing mastectomies, it remains true that it is a robotic procedure that received widespread attention, was adopted quickly, and ultimately seems to have had worse outcomes.
In fact, the FDA referenced that radical hysterectomy study when it published two warnings in 2019 and 2021, cautioning against the practice of robotic breast surgery without a proper randomized controlled trial with long-term evidence on cancer metrics. The FDA asked that anyone experimenting with robotic nipple-sparing mastectomy should do so only within the boundaries of a clinical trial that it approved.
Soon after, Intuitive — the company that manufactures the single-port da Vinci machine — sponsored a randomized controlled trial that was set to wrap up in 2031 and even published data from the initial 74 participants this year. It concluded that using the da Vinci single-port machine was feasible for robotic nipple-sparing mastectomies and that its safety was comparable to the open procedure in terms of early outcomes after the surgery and the ability to neatly remove tumors. It is worth noting that the robot-assisted surgery takes longer than the open one — so the patient spends more time under anesthesia — but the researchers largely attributed that to the unfamiliarity of surgeons with robotic surgery. They believed that operating time would reduce with better training and exposure to the machine.
The researchers themselves acknowledge that published results from this study were focused on safety and early post-surgical outcomes, and they say that long-term oncological outcomes will likely be published later. The study was also statistically underpowered due to the small number of participants — enrollment of patients was stopped after FDA clearance was granted in December 2025.
In a written statement to Vox, an Intuitive spokesperson said, “Da Vinci SP’s clearance for NSM was supported by a robust evidence package for this indication, including a U.S. randomized controlled trial comparing da Vinci SP with open surgery and global evidence from some of the regions where da Vinci SP was already approved for NSM — Europe, Japan, Korea and Taiwan.” They added that the FDA cleared the device after stringent review of the evidence.
The company also said that patient safety is their top priority and noted that they will continue generating evidence for both short- and long-term outcomes in patients undergoing robotic nipple-sparing mastectomy using the da Vinci single-port machine globally.
The FDA cleared the da Vinci single-port for use in nipple-sparing mastectomies under what’s known as the 510(k) process, which is used for “low to moderate risk” devices if they are “substantially equivalent” to another device that has already been cleared by FDA before. In a written statement to Vox, the FDA said that the clearance reflects their evaluation of the evidence submitted by Intuitive and available scientific evidence under the “applicable regulatory framework.”
“Importantly, the clearance is based on the device’s use as a surgical tool, meaning the sponsor demonstrated that the device can be used safely as a tool in performing nipple-sparing mastectomy procedures,” said the FDA. “This differs from evaluating the device as a potential treatment for cancer, which would require evidence supporting its effectiveness in treating the disease.”
In other words, the FDA found that the device was safe for surgery, but it withheld judgment on whether performing robotic nipple-sparing mastectomies with the da Vinci single-port surgical system would lead to optimal cancer outcomes. In their statement, the FDA also said that they would continue keeping an eye on it (along with other devices they have cleared) and may take additional regulatory action if patient safety is affected.
Despite the initial data and what Farr describes as “favorable” evidence from studies outside the United States, some critics strongly believe that no conclusive long-term evidence is available to show that robotic mastectomies are at least as effective as open mastectomies in treating cancer.
Dr. Laurie Kirstein, surgical oncologist at Memorial Sloan Kettering Cancer Center, said that most of the studies done to date establish that robotic nipple-sparing mastectomies are technically safe, which is the first level of evidence needed to evaluate whether they can be more widely performed. For example, such studies consider metrics like whether patients experience bleeding complications or abnormal levels of skin or tissue death called necrosis.
But, she also notes, the evidence still doesn’t move beyond that to establish strong cancer outcomes, either because the clinical studies are not designed to test for those outcomes or because there isn’t data on long-term outcomes from a randomized controlled trial in a well-defined patient population.
“After a mastectomy, you’re only going to be getting a physical exam twice a year, right? So there’s no imaging screening,” Kirstein said. “So the mastectomy has to be good enough oncologically to reduce the amount of breast tissue left behind, and that has to be done and proven without a shadow of a doubt, and unfortunately right now those studies don’t exist.”
What Kirstein is getting at is that the mastectomy surgery, which removes most or all breast tissue, is meant to be the ultimate safeguard. Once the patient undergoes that procedure, regular breast cancer screenings like mammograms generally stop, unless the doctor or patient feels something is abnormal, and the patient is instead monitored through physical exams. If any breast tissue is accidentally left behind, it could be harder to catch a cancer recurrence early.
In contrast, people who opt for a lumpectomy — a surgery to remove breast tumors while preserving the remainder of the breast tissue — keep getting regular breast image screenings. That’s why surgeons are asking for irrefutable proof that the robotic approach removes the breast tissue just as thoroughly as open surgery does. In the absence of that certainty, some worry that the possibly more selective excisions in robot-assisted surgery may leave an opportunity for cancer to spring up, possibly unmonitored.
A medical catch-22
Bringing exciting new medical technologies to the market in a responsible manner almost inevitably invites a paradox of sorts. Irrefutably showing that a new surgery is at least equivalent to existing methods and safe, requires performing it on real patients to gather data. And yet without data, there is considerable risk in subjecting patients to it.
Clinical trials are meant to resolve that tension by testing a new technique under close oversight before it becomes routine. In this case, though, the FDA cleared the robot before Intuitive’s trial was complete, and the trial stopped enrolling patients soon after.
“I truly believe it is a better surgery when done properly,” Farr said. “It was a blessing and a curse that it was approved when it was.”
For years, only her own study team could use the robot for these surgeries. Now she can teach it to her residents, fellows, and surgeons around the country. But once a device is cleared, “there’s really no further regulation in terms of who can do it and who can’t,” she said. That decision now rests largely with hospitals and with patients.
Dr. Rosa Hwang, a surgical oncologist at the University of Texas MD Anderson who worked on Intuitive’s US trials, said surgeons will need dedicated training to learn how to perform robotic nipple-sparing mastectomies safely. She chooses her own robotic nipple-sparing mastectomy patients carefully.
“I err on the side of being conservative for the robotic nipple-sparing mastectomy,” she said. Someone who might be a reasonable candidate for an open nipple-sparing mastectomy, for example, isn’t automatically one for the robotic version.
Farr said that she can understand why critics are skeptical about the existing data on robotic nipple-sparing mastectomies and while she believes the surgery needs more study, she doesn’t think that’s a reason to abandon it. She believes that criticism is healthy for the field, ultimately helping surgeons learn more and better test for the best outcomes.
“I have a lot of respect for the people who have criticized me,” Farr said. “The response to critics,” she said, “should be not with defense but with data.”
If there is one thing that surgeons on both sides of the robotic mastectomy debate agree on, it’s that patients are asking for this. For women like Brasure and Aziz, beating breast cancer or avoiding it altogether was never the only goal. They also wanted to come out the other side living normal, safe lives in bodies that still felt like their own. The robot may or may not turn out to be the best way to get there — only long-term data will tell. But what’s already clear is that for many women, sensation is no longer an afterthought.
“Nothing feels the same,” Aziz said, “but I have feeling pretty much everywhere, and I feel good.”