January 16, 2025, Bengaluru: Cancer remains the illness most feared across the globe. To combat these ongoing challenges, cancer diagnostics techniques and technologyadvancements are helpingearly detection rates, improving life expectancy, and bringing us closer to cancer care.
In this ongoing fight against cancer, treatments are being revamped by adopting modern technologies that have moved cancer care forward by leaps and bounds and enhancing patients’ quality of life. Among these advancements, Robotic Nipple Sparing Mastectomy (RNSM) combined with Tiloop implant reconstruction stands out as a groundbreaking development in breast surgery.
Apollo Cancer Centre (ACC), Bengaluru, successfully conducted India’s first Robotic Nipple Sparing Mastectomy-with Titanised Polypropylene (TPP) Mesh for breast implant reconstruction on a 37-year-old Latha who was diagnosed with right breast cancer in April 2024. The size of her lump was 3 cms x 2.5 cms in size with Lymph nodes in the axilla enlarged.
The expert team lead by Dr. Jayanti Thumsi, Lead & Robotic Breast Surgeon, Apollo Cancer Centre, Bangalore, gave her chemotherapy (NACT) x 16 cycles. She is BRCA negative
In Sept 2024, the team performed RNSM with TiLoop and breast implant reconstruction. She was discharged with a drain which was removed after a week. Her tubes and ovaries were also removed as she was Estrogen Receptor (ER) and Progesterone Receptor (PR) positive and Human Epidermal Growth Factor Receptor2 (Her2) was negative. Subsequently, she was also given radiation therapy which ended in Nov 2024. She’s now on Hormone Therapy and doing very well.
Another cancer winner, a 48-year-old Sneha T(name changed) was diagnosed with right cancer breast in October 2024. She was treated with RNSM with TiLoop and implant reconstruction done in November 2024.
She had Mucinous ca breast no chemo or radiation therapies were given. She is currently on Hormone Therapy and doing well.
Sneha T shared her thoughts on the treatment, saying, “I am glad I made the right decision. to undergo RNSM with implant reconstruction using Tiloop Mesh. Initially, I was anxious about losing my breast as part of the cancer treatment. Today, I am immensely satisfied- not only am I free from the disease, but my breast has been beautifully reconstructed, and the symmetry on both sides has been perfectly maintained.”
Robotic nipple-sparing mastectomy is a minimally invasive procedure designed to remove breast tissue while preserving the skin envelope, nipple-areola complex (NAC), and natural breast contours. Performed using the da Vinci Surgical System, this approach provides surgeons with enhanced dexterity, precision, and 3D high-definition imaging for meticulous dissection. The use of small, hidden incisions, ensures minimal visible scarring. This technique offers multiple advantages, including oncological safety through a thorough removal of breast tissue, aesthetic preservation of the NAC and skin, and reduced trauma leading to decreased pain, blood loss, and recovery time
The Tiloop Bra, a titanium-coated polypropylene mesh, is a transformative addition to RNSM, enhancing reconstructive outcomes. Acting as a scaffold, it provides structural support to hold the implant in place, prevents displacement, and promotes seamless tissue integration. Its blocompatible design minimizes the risk of complications such as capsular contracture, while its ability to enhance symmetry and shape ensures a more natural appearance.
The workflow for this combined procedure begins with preoperative planning, including imaging studies and consultations to assess the tumor’s location, size, and the patient’s sultability for RNSM. During the robotic surgery, a small incision allows for precise tissue removal while preserving the NAC. Subsequently, the TiLoop mesh is placed along with the breast implant to reconstruct the breast. Postoperative care involves monitoring for healing and recovery, with most patients resuming normal activities within a few weeks,
The combined benefits of RNSM and Tiloop reconstruction include a minimally invasive approach that reduces scarring and recovery time, improved cosmetic results due to NAC preservation, greater patient comfort through less postoperative pain, and a lower risk of implant-related complications like migration or contracture.
Traditionally, breast reconstruction in India has predominantly utilized autologous tissue techniques, notably the Latissimus Dorsi (LD) flap. This method involves harvesting tissue from the patient’s back, including the latissimus dorsi muscle, to reconstruct the breast mound. The procedure is complex, involving extensive tissue dissection, leading to increased surgical time, higher chances of postoperative complications, and prolonged recovery periods.
Dr. Jayanti Thumsi, Lead Surgeon and Robotic Breast Surgeon at Apollo Cancer Centre, Bangalore, and the first in India to treat 16 women with breast cancer using the TiLoop Mesh, shared her insights: “Robotic nipple-sparing mastectomy with TiLoop implant reconstruction represents the perfect blend of precision technology and innovative reconstructive techniques providing women with a safer and less invasive reconstruction option, and encouraging more Indian patients to consider reconstruction post-mastectomy. This advanced approach not only ensures effective cancer clearance but also preserves a woman’s femininity, significantly enhancing her quality of life after breast cancer treatment. Ultimately, the goal is to address the physical disease while also prioritizing the patient’s emotional well-being.”
Mr Dinesh Madhavan, President Group Oncology and International, Apollo Hospitals Enterprise Ltd (AHEL) said: “Robotics has revolutionized cancer care, implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and faster recovery. The use of Titanszed Polypropylene Mesh aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. Advancements through Robotic procedures like Robotic Nipple Sparing Mastectomy with Tiloop and breast implant reconstruction, have led to faster recovery and fewer complications in patients. This is a testament to the persistent pursuit of progress in healthcare.”
Dr Manish Mattoo, CEO Karnataka & Central Region, AHEL, said, “The introduction of TiLoop mesh is likely to address many concerns that have traditionally deterred Indian women from opting for reconstruction. Its minimally invasive nature, combined with better outcomes and shorter recovery times, makes it an attractive option for patients hesitant about traditional procedures. Moreover, the positive experiences of early adopters can help combat cultural stigmas and encourage others to consider reconstruction.”
This innovative approach exemplifies the continuous evolution of medical technologies aimed at enhancing patient outcomes and experiences in the realm of breast cancer treatment.
In India, breast cancer rates are notably high, especially among young women, constituting 48% of cases.
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