In response to growing concerns over “fake-looking” results and rising revision surgeries in aesthetic breast procedures, a group of plastic surgeons from around the world has launched a new international consensus on natural beauty in breast aesthetics, presented at Palazzo Turati in Milan.

With breast augmentation now an almost $3 billion global industry growing at 7.5% annually, experts warn that the trend toward hyper-curated aesthetics—amplified by social media—risks prioritizing trends over health and harmony. The new consensus provides a science-based framework for natural outcomes tailored to each woman’s anatomy and long-term well-being.

“The demand for aesthetic surgery is rising, but too often shaped by unrealistic expectations,” says professor Roy De Vita, plastic surgeon at the Istituto dei Tumori Regina Elena in Rome, in a release. “Many women walk into their first consultation asking for a specific brand or implant shape they saw on Instagram. But implants are medical devices just like orthopedic or cardiac implants—not accessories. You wouldn’t choose a heart valve that way.”

The consensus addresses six of the most commonly misunderstood areas of breast surgery, from implant choice and patient expectations to safety protocols and facility selection. The recommendations reflect a growing global shift toward individualized, anatomy-based approaches that deliver subtle, long-lasting beauty.

The ‘Natural Breast Beauty’ Approach

“Large doesn’t equal beautiful,” says Patrick Mallucci, MD, British plastic surgeon and co-author of an international ideal breast shape study, in a release. “Beauty is about proportions—typically a 45:55 ratio between the upper and lower pole of the breast. This creates a natural, slightly concave upper area and a full, rounded lower area. It’s geometry, not guesswork.”

The Natural Breast Beauty methodology blends clinical precision with a growing cultural demand for results that feel authentic—not artificial. “Patients increasingly want to look and feel good without being judged by extremes,” says Mallucci in a release. 

Educating Women, Combating Misinformation

The global breast implant market reached $2.78 billion in 2024, with $890 million in the US alone and $1.89 billion internationally. That number is expected to double by 2034, fueled by both reconstructive and aesthetic procedures.

“This is not just a business—it’s a responsibility,” says professor Karsten Hemmrich, CEO of POLYTECH Health & Aesthetics and former plastic surgeon, in a release. “We’re seeing two major global shifts: women seeking natural, harmonious outcomes and a growing demand for safety and scientific rigor in device manufacturing.”

The consensus also serves as a call to action against misleading content online. “Social media is full of unrealistic before-and-after photos, DIY comparisons, and influencer promotions,” says Mariangela Dal Prá, managing director Italy and head of sales Central Europe at POLYTECH Health & Aesthetics, in a release. “We want women to be empowered—not manipulated. Sometimes the best decision is to wait, or even to avoid surgery altogether.”

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A new option for neck rejuvenation without traditional surgical incisions is now available to patients through a hybrid non-surgical procedure offered by Amir Ghaznavi, MD, MBA, FACS, a dual board-certified plastic and reconstructive surgeon, practicing in Herndon, Va, at AMG Plastic Surgery.

Combining Established Technologies

The procedure integrates three technologies: MyEllevate suture suspension, liposuction, and Renuvion (J-Plasma) radiofrequency skin tightening. According to Ghaznavi, the combination enables targeted treatment of submental fullness, skin laxity, and jawline definition with minimal invasiveness.

“MyEllevate helps provide structural support and contour, while liposuction removes excess fat and Renuvion tightens the skin,” said Ghaznavi. “Each element addresses a different anatomical concern without requiring open surgery.”

Addressing Patient Demand for Minimally Invasive Options

The technique is designed for patients in their 30s to 60s who want visible improvements in their neck and jawline without undergoing a full neck lift. Results are typically seen immediately, with further skin tightening continuing in the months following the procedure. No visible scarring and reduced recovery time are among its key advantages.

Ghaznavi noted that the procedure is suited for individuals who are not yet candidates for surgical intervention or prefer to avoid the downtime associated with more invasive techniques.

Implications for Private Practice Surgeons

The hybrid approach reflects a growing trend among patients seeking non-surgical or minimally invasive cosmetic procedures. For plastic surgeons in private practice, offering combination therapies may meet increasing demand for results-driven treatments that fall between injectables and traditional surgery.

Photo: AMG Plastic Surgery

For women with early-stage breast cancer, breast-conserving therapy (BCT), including radiation therapy (RT), leads to progressive reduction in breast size over time, reports a study in the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons. 

“Our findings suggest that women undergoing BCT/RT may lose approximately 20% of breast volume within a year, with continued reductions through five years,” says Chris Reid, MD, of University of California San Diego, in a release. “Anticipating these changes may help guide patient expectations and assist surgical planning to restore women after breast cancer treatment.”

New Data on Changes in Breast Size after BCT for Early Breast Cancer

BTC—consisting of limited surgery (lumpectomy) and RT—is the preferred treatment for many women with early-stage breast cancer. It offers survival rates similar to those of mastectomy, with more favorable physical, psychological, and quality of life outcomes.

However, RT has adverse effects on breast tissue, including breast shrinkage due to radiation-induced tissue atrophy and fibrosis. While this long-term side effect is well-recognized, there are few data on the extent or time course of breast volume loss after BCT.

Reid and colleagues measured changes in breast volume in 113 patients who underwent BCT/RT for early-stage (T1) breast cancer between 2005 and 2023. Measurements were made using mammograms obtained before and after BCT and up to five years later. The researchers also examined the impact of initial breast size and other factors on volume loss.

Reflecting the size of the tumor, breast volume decreased by an average of 9.2% after lumpectomy. Breast volume continued to decrease over time, even after the immediate side effects of radiation resolved. After one year, the average decline in breast volume was 19.3%, in addition to the tissue removed at surgery.

Implications for Patient Expectations and Treatment Planning

“Additional volume change was observed yearly for five years,” the researchers write. By that time, the average decrease in breast size was 26.6%. Consistent with previous studies of breast shrinkage following BCT, “progressive volume loss was seen in all patients.”

Women with larger breasts and relatively smaller tumor volumes (measuring less than 10% of breast volume) had greater total breast shrinkage: 29.5%, compared to 21.7% for those with smaller breasts. Other factors associated with greater volume loss included smoking, diabetes, and receiving cytotoxic chemotherapy in addition to RT.

The study provides new evidence on breast shrinkage after BCT. Expected breast shrinkage is approximately 20% within the first year, progressing to about 26% by five years. Especially with the growing emphasis on patient satisfaction in evaluating the outcomes of breast cancer treatment, the findings highlight the need to discuss long-term changes in breast volume in patients receiving undergoing BCT/RT.

The greater volume loss in patients with larger breasts raises concerns about breast asymmetry—which is a common concern after BCT. “Anticipating these changes may help guide patient expectations and assist surgeons in planning reconstructive procedures to attain symmetry post-treatment,” Reid says in a release. 

The authors discuss key areas for further research, including the effects of different treatment techniques on breast volume changes and the need for more objective approaches to measuring breast volume.

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Establishment Labs Holdings Inc, a medical technology company specializing in breast aesthetics and reconstruction solutions, noted a presentation of an update on the Motiva US IDE Study regarding five-year patient follow-up data for primary augmentation subjects. 

The medical director of the study, Caroline Glicksman, MD, who is also an investigator in the study, will present the results at The Aesthetic MEET 2025, the annual meeting of The Aesthetic Society, in Austin, Texas.

Glicksman will present data for the 451 primary augmentation patients enrolled in the study through the five-year follow-up visit. Patient compliance in the primary augmentation cohort of the trial at four years was 88.5%. The five-year, by-patient, Kaplan-Meier risk rates of first occurrence of complications for patients (95% confidence interval) in the primary augmentation cohort were as follows:

“At the mid-point of the 10-year core study, Motiva implants continue to show low rates of complication,” says Glicksman in a release. “The consistency in these clinical results is particularly notable, as we have seen no increase in capsular contracture or in the number of patients with suspected or confirmed rupture since we began reporting at two years. Overall, patient follow-up remains very high, and the rates of complication remain very low.”

Establishment Labs received approval from the US Food and Drug Administration for the use of Motiva SmoothSilk Ergonomix and Motiva SmoothSilk Round breast implants in primary and revision breast augmentation on Sept 26, 2024.

“Our momentum in the US continues to exceed expectations,” says Peter Caldini, Establishment Labs’ interim CEO, in a release. “This is driven by differentiated clinical data, along with the complete lack of innovation in this market for years. Our core thesis is proving true: better technology can improve patient outcomes, take market share, and expand the market. We now have over 800 accounts on board with more than 550 placing orders.”

¹ MRI cohort N=176

² Any surgery on the breast or chest area, device or non-device related, including size change

³ Any device or non-device related event, including reoperation

File photo / Motiva implant

BD (Becton, Dickinson and Company), a global medical technology company, announced the first patient treated in an Investigational Device Exemption (IDE) clinical trial intended to advance BD’s efforts to achieve Premarket Approval (PMA) from the U.S. Food and Drug Administration (FDA) for the use of GalaFLEX LITE Scaffold in decreasing capsular contracture (CC) recurrence during breast revision surgery.

Understanding Capsular Contracture

Capsular contracture, a condition where the scar tissue naturally forming around the implant becomes unusually hard, causes pain and anatomical displacement and is its most frequent complication during implant-based breast surgery, with overall incidence ranging from 10% to 20%. At advanced stages, CC necessitates treatment through surgical intervention, and when performed using conventional techniques, the risk of recurrence may be as high as 54%, according to a press release from BD. 

About the STANCE Clinical Trial

This multi-center Study of GalaFLEX LITE Poly-4-Hydroxybutyrate (P4HB) Scaffold in Treatment of Capsular Contracture after Breast Implant Augmentation (STANCE) is aims to evaluate whether GalaFLEX LITE Scaffold, when used in breast revision surgery, decreases the likelihood of CC and or malposition. 

BD’s Commitment to Surgical Innovation

“This milestone marks a significant advancement in our efforts to achieve FDA Premarket Approval for our first breast indication for GalaFLEX LITE Scaffold and reinforces the company’s commitment to improving patient outcomes through innovative technologies that reduce surgical complications,” said Rian Seger, worldwide president of the BD Surgery business. “Our team has worked closely with the FDA to help address a critical medical complication arising from implant-based breast surgery, and the first patient treated brings us closer to delivering a much-needed solution.”

How GalaFLEX LITE Scaffold Works

According to the company, GalaFLEX LITE Scaffold is engineered to conform to the desired anatomical structure and provide immediate strength and stability throughout the wound healing period. It is made from P4HB, a fully absorbable, biologically-derived polymer with more than 10 years of clinical use supporting hernia repair and other plastic and reconstructive procedures where soft tissue weakness or deficiency exists.

Surgeons Highlight the Importance of the Study

“Participating in this trial underscores our commitment to innovation and providing the best evidence-based care for patients suffering from capsular contracture, offering them hope and solutions for the future,” said Dr Shawna Kleban, the board-certified plastic surgeon who performed the inaugural procedure. “This trial allows participants to help identify a solution for themselves and for future patients.”

Dr Caroline Glicksman, the study’s National Principal Investigator from Sea Girt, NJ, added, “As an early adopter of the P4HB technology, we are excited to see the potential benefits of GalaFLEX LITE Scaffold in improving patient outcomes in breast revision surgeries. This study is crucial in providing the data FDA requires for a specific breast indication that will advance our ability to deliver better solutions for breast surgery patients.”

GalaFLEX LITE Clinical Trial Sites and Enrollment

The following five sites are currently enrolling patients:

• HKB Cosmetic Surgery (various locations, North Carolina) – Principal Investigator: Dr Bill Kortesis; Sub-Investigators: Dr Gaurav Bharti, Dr Shawna Kleban, Dr Brett Baker
• Billington Plastic Surgery (St Petersburg, Fla) – Principal Investigator: Dr Alicia Billington
• The Practice Plastic Surgery (Beverly Hills, Calif) – Principal Investigator: Dr Kelly Killeen; Sub-Investigator: Dr Lisa Cassileth
• Plastic Surgery Institute of New York (New York) – Principal Investigator: Dr Matthew DelMauro; Sub-Investigator: Dr Adam Shaffner
• Newport Plastic and Reconstructive Surgery Associates (Newport Beach, Calif) – Principal Investigator: Dr Hisham Seify
• Essential Medical Research (Tulsa, Okla) – Principal Investigator: Dr John Tedesco

GalaFLEX LITE Study Goals and Randomization

The trial is expected to enroll at least 250 patients across 40 investigative sites and aims to demonstrate the device’s safety and efficacy in breast implant revision surgery to treat capsular contracture. 

Details of the STANCE Study

STANCE (NCT05945329) Study is an ongoing prospective, randomized, controlled, multi-center study to assess the safety and efficacy of GalaFLEX LITE scaffold in revision surgery for reduction of capsular contracture recurrence and/or malposition in implant-based breast augmentation patients versus patients undergoing conventional revision surgery with no supportive matrix or acellular dermal matrix (ADM). Patients will be randomized 2:1 to receive either GalaFLEX LITE Scaffold or standard care (no ADM or matrix placement). 

Photo: BD

For patients undergoing nerve transfer surgery for facial palsy, Botox injections can improve facial symmetry by reducing overactivity of the muscles on the unaffected side, suggests a study in the March issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons. 

The added benefit of Botox reflects modifications in brain functional network connectivity, according to the new research, led by Ye-Chen Lu, MD, PhD, and Wei Wang, MD, PhD, of Shanghai Jiao Tong University School of Medicine, China. They write, “These findings imply that enhanced connectivity between brain functional networks play a vital role in the recovery process from neurological disorders.”

BoNT-A Improves Outcomes of Surgery for Facial Palsy

Facial nerve injury can cause paralysis on the affected side of the face, leading to functional and cosmetic impairments. For patients with this condition, nerve transfer surgery is recommended to restore facial nerve function and symmetry.

However, many patients have persistent impairment after surgery, especially drooping of the corner of the mouth (oral commissure) on the affected side. This condition has been linked to overactivity of the muscles on the opposite side, leading to facial asymmetry even at rest.

Such patients have been successfully treated using botulinum toxin-A (BoNT-A; best known by the brand name Botox) to produce temporary relaxation of overactive muscles on the unaffected side. Previous studies suggest lasting improvement, even after the effects of BoNT-A fade.

Benefits Linked to Changes in Brain Network Connectivity

“We hypothesize that BoNT-A treatment triggers extensive cortical plasticity, offering a potential explanation for its long-lasting therapeutic impact on patients with facial asymmetry,” the researchers write. 

They used functional magnetic resonance imaging (fMRI) scans to assess functional activity of brain networks before and after surgery and BoNT-A treatment.

The study included 38 patients with facial palsy and “severe oral commissure drooping” after surgery for benign tumors (acoustic neuromas). All underwent nerve transfer surgery followed by facial training and rehabilitation. In addition, patients were randomly assigned to a treatment group receiving a series of BoNT-A injections of the facial muscles on the unaffected side or a control group receiving no BoNT-A.

Patients receiving BoNT-A had significant improvement in facial asymmetry. “BoNT-A injections improved facial static function without affecting smile function,” the researchers write. As in previous studies, the benefits persisted beyond six months, after the effects of BoNT-A wore off.

Before surgery and one year later, patients underwent fMRI scans to assess changes in in brain functional network connectivity. Of nine resting state networks (RSNs) studied, five showed “significant differences of spatial distribution” between groups. Patients receiving BoNT-A “displayed an overall stronger interaction between several RSNs” – notably including the sensorimotor and visual networks.

“Our research provides evidence of long-term and widespread changes in cerebral networks among facial paralysis patients,” Lu and Wang and coauthors write. These effects may explain why the improvement persists even after the effects of BoNT-A dissipate.

BoNT-A injections “may create a “window of time for nerve reanimation, allowing the brain to learn and restore proper facial muscle activity.” The researchers conclude, “These findings imply that enhanced connectivity between brain functional networks play a vital role in the recovery process from neurological disorders.”

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Emface, a non-invasive facial treatment designed to treat both the skin and underlying muscles for a more youthful, lifted appearance, has reached 1 million treatments worldwide in under two years. 

“The ability to stimulate elevator muscles allows us to lift facial features from within—something that was never possible before with injectables or traditional energy-based devices,” says Yael Halaas, MD, FACS, a facial plastic surgeon from NYC, USA.

Developed by BTL, Emface has expanded its capabilities over the past year with the introduction of specialized submental and under-eye applicators. The latest eye applicators received positive feedback from attending medical experts upon their launch at the IMCAS World Conference in Paris in January 2025, according to a release from the company.

“Emface isn’t just a procedure—it’s a facial multiplatform that allows us to treat different areas based on each patient’s unique needs. It’s a game-changer for anyone looking for natural-looking facial rejuvenation,” says Kyungkook Hong, MD, PhD, a board-certified dermatologist from Seoul, Korea.

More practitioners continue to integrate Emface into their treatment offerings, according to the company. 

“Reaching 1 million treatments in just two years is a testament to Emface’s groundbreaking technology and the value it brings to medical professionals,” says Tomas Schwarz, CEO of BTL, in a release. “We remain committed to expanding this platform and further advancing non-invasive facial treatments in the years ahead.”

BTL’s products include Emsculpt Neo, Emface, Exion, Emsella, Exomind, as well as HIFEM, HIFES, and EXOTMS procedures. 

Photo caption: Before and after photos of a patient receiving Emface

Photo credit: BTL courtesy of Joel L. Cohen, MD

Xironetic announced the publication of data from a recent study evaluating the potential benefits of augmented reality (AR) guidance with Xironetic’s IntraOpVSP system in patients undergoing craniofacial surgery. 

The results of the study were published in FACE, founded by the American Society of Maxillofacial Surgeons and the American Society of Craniofacial Surgeons. IntraOpVSP is a US Food and Drug Administration (FDA)-cleared system for AR guidance that provides three-dimensional patient imaging data to the surgeon during surgery. 

Study Methodology and Results

In a retrospective cohort study, the amount of blood loss was compared between patients who received AR guidance in their surgery (n = 17) and patients who did not (n = 62). Analysis of calculated blood loss data from these cohorts indicated that AR guidance provided statistically significant blood loss reduction as measured by estimated red cell volume (ERCV), with an ERCV of 43.7% for the cohort with AR guidance and an ERCV of 61.9% for the cohort without (p < 0.05). 

Additional benefits reported in the study were reduced sinus proximity bleeding, reduced dural injuries, and reduced transfusion volumes.

“We are able to navigate around the multitude of blood vessels in the craniofacial area because we can visualize them more intuitively,” says Christian El-Amm, MD, chief of pediatric plastic surgery at Oklahoma Children’s Hospital, in a release. “Our patients suffered less blood loss, and there was a trend towards fewer blood units transfused and less donor exposure. Larger multicenter studies are now underway to confirm and explore potential benefits towards patient safety.”

The results from the study suggest that AR can increase surgical safety through reduced blood loss and sinus proximity bleeding during a craniotomy, promoting improved patient outcomes. Additional investigations are underway to confirm these results and further evaluate the benefits of AR guidance in craniofacial surgery.

Summary:

Xironetic announced new study findings demonstrating that its IntraOpVSP augmented reality (AR) system significantly reduces blood loss in craniofacial surgery. The retrospective cohort study, published in FACE, compared 17 patients who received AR-guided surgery to 62 who did not, showing a statistically significant reduction in estimated red cell volume (ERCV) loss—from 61.9% to 43.7% (p < 0.05). The study also reported less sinus proximity bleeding, fewer dural injuries, and reduced transfusion volumes in patients who underwent AR-assisted procedures. Researchers suggest that AR visualization allows surgeons to navigate complex vascular structures more intuitively, improving patient safety and outcomes. Larger multicenter studies are now underway to further evaluate these benefits.

Key Takeaways:

• AR Guidance Reduced Blood Loss – Patients who underwent AR-guided craniofacial surgery had a significant decrease in estimated red cell volume loss (61.9% to 43.7%).
• Additional Benefits Observed – The study reported less sinus proximity bleeding, fewer dural injuries, and reduced transfusion volumes in AR-assisted procedures.
• Further Research Underway – Larger multicenter studies are being conducted to confirm AR’s role in improving surgical safety and patient outcomes.

ID 160434551 © Robert Kneschke | Dreamstime.com

Key Takeaways:

• Preservé builds on the technology of Mia Femtech to offer a less invasive alternative to traditional breast augmentation, enhancing safety, recovery, and aesthetic outcomes.
• The new breast tissue preservation platform could expand the pool of women considering augmentation while driving growth and profitability for Establishment Labs.
• After debuting in Brazil, Preservé will be introduced in other markets worldwide, though it is not yet approved for commercial use in the U.S.

Establishment Labs Holdings Inc, a global medical technology company focused on women’s health and wellness in breast aesthetics and reconstruction, announced it has launched Preservé in Brazil, the first country in its global rollout. Preservé is the second product in the company’s minimally invasive platform, building upon the technologies and techniques developed with Mia Femtech, Establishment Labs’ minimally invasive experience.

Addressing Patient Concerns with Minimally Invasive Solutions

“These are not small innovations, this is an entirely new era for aesthetic breast surgery,” said Juan José Chacón-Quirós, founder and CEO of Establishment Labs. “Whereas Mia made minimally invasive breast aesthetics possible for women looking for a one to two cup enhancement, Preservé allows less invasive breast surgery for the day-to-day breast augmentation patient.”

“Historically, many women have not been convinced by traditional methods and legacy techniques,” Chacón-Quirós continued. “With Mia and Preservé, we have solutions that address these concerns. The technology platform of breast tissue preservation allows plastic surgeons to create natural results with less disruption of the patient’s breast tissue. By improving safety profiles, recovery times, and achieving the breast aesthetic patients are looking for, breast augmentation may now be possible for women that otherwise never would have considered it—as well as making the decision easier for many who were already considering. After Brazil, Preservé will rollout globally over the next few years, and this should contribute to top line growth and profitability.”

Regulatory Status and U.S. Availability

The medical devices used in Preservé are not yet approved for commercial distribution in the United States.

Breast Augmentation with Tissue Preservation

According to the company, Preservé was designed to preserve breast tissue during aesthetic breast surgery, maintaining the structural anatomy and function of the breast for more stable and natural outcomes when compared to traditional breast augmentation. Preservé reportedly leverages Establishment Labs’ proprietary minimally invasive surgical tools coupled with the Ergonomix2 implants, which feature the patented SmoothSilk surface, designed for enhanced biocompatibility and softness; in addition, their shape adapts as the body changes position. Preservé is intended for primary augmentations up to four cups, hybrid augmentations, and mastopexy augmentations.

“Breast tissue preservation is a new paradigm in breast aesthetics. With less invasive breast procedures made possible by technology pioneered by Establishment Labs, we can address many of the complications that lead to reoperations,” said Dr Kamakshi Zeidler, San Francisco plastic surgeon and head of the Femtech board of Establishment Labs. “Preservé is an incredible new choice for women considering breast augmentation because it speaks to many of their aspirations, including smaller scars, quicker recovery, maintaining breast sensation, and avoiding unnecessary reoperations.”

Launch Event and Global Expansion Plans

The commercial launch of Preservé took place last weekend at the Brazilian Breast Meeting in Rio de Janeiro with over 300 surgeons in attendance and included live surgery and academic sessions. This year additional launches of Preservé are planned around the world.

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Summary:

Surgeons at Rutgers New Jersey Medical School and University Hospital are the first in New Jersey to perform robotic-assisted breast reconstruction, offering a less invasive alternative to traditional surgery. The technique, used in latissimus dorsi flap reconstruction, allows surgeons to access back muscles through a small underarm incision rather than a large back incision, reducing scarring and recovery time. The team is evaluating the approach’s broader applications in reconstructive surgery and plans to publish their findings.

Key Takeaways:

1. Robotic-assisted breast reconstruction debuts in New Jersey. Rutgers surgeons are the first in the state to use robotics for latissimus dorsi flap reconstruction, potentially improving patient recovery and outcomes.
2. Minimally invasive technique reduces scarring and recovery time. The robotic approach replaces a large back incision with a small cut under the arm, limiting tissue damage and expediting healing.
3. Surgeons see potential for broader reconstructive applications. The team is exploring robotics for other procedures, including abdominal flaps and thigh muscle harvests, and plans to track patient outcomes for future study.

Two surgeons at Rutgers New Jersey Medical School and University Hospital are the first in the state to use robotics in breast reconstruction after cancer treatment. Surgery with the robot is less invasive than traditional surgery, so patients typically heal faster and have smaller scars.

Edward Lee, MD, a plastic surgeon, and Danbee Kim, MD, a robotic surgeon, are the first to perform the procedure in New Jersey, and they believe it will significantly improve patient outcomes. More importantly, they think it demonstrates that robotic machines may soon improve many other reconstructive surgeries.

“This is just the beginning,” says Lee, a division chief who also directs the school’s plastic surgery residency training program, in a release. “We’re exploring ways to use the robot for thigh muscle harvests, abdominal flaps, and more. The potential to improve outcomes across reconstructive procedures is enormous.”

A Less Invasive Approach to Breast Reconstruction

The pair, who perform the procedures at University Hospital in Newark, began with the breast surgery, known as a latissimus dorsi flap reconstruction, several months ago. The procedure removes muscles from the patient’s upper back to help replace tissue lost to mastectomy.

This type of reconstructive surgery has traditionally required a long incision stretching halfway across the back that takes months to heal and leaves a large scar. The surgical robot allows them to cut under the patient’s armpit and access the back muscle without any incision on the back. This technique does less damage, so patients heal faster and with less scarring.

“The robot has four arms, one for a camera and three more you can manipulate to operate. If you’ve ever hung a painting, you’ll know how nice it would be to have a third arm,” Kim says in a release.

The extra arms also reduce the need for surgical support staff who typically hold cameras, retractors, and other surgical tools, so robotic surgery could potentially cut medical costs going forward.

“And the robot camera’s high-definition allows us to better identify tissue and perform more precise surgeries than in traditional surgery,” Kim says in a release.

Expanding the Role of Robotics in Surgery

Breast reconstruction alone is a significant potential use case for robotic surgery. Surgeons in the US perform more than 100,000 reconstructions every year after cancer treatment. Latissimus dorsi flap surgeries are only one of many techniques for reconstructing breast tissue, but they are a common procedure for patients who will receive radiotherapy after cancer removal.

“Radiation cooks the skin and tissue, making it shrivel and tighten,” Lee says in a release. “Adding an extra layer of soft tissue to the surgery site provides more padding to the implant that provides most of the volume in the reconstruction.”

The robot-assisted surgery initially took longer than traditional surgery, but Lee and Kim have seen operative times decrease with experience. Other surgeons using the robot for other surgeries like prostate removal, colon cancer, and other surgeries see a similar learning curve.

“We’re building on the innovative work of our international colleagues,” says Kim, who trained in South Korea. “Our goal is to refine the technique, expand its applications, and make it more widely available to patients who can benefit from it.”

Training and the Future of Robotic Surgery

Robotic surgeries were slow to catch on—the surgical robot from Da Vinci, which dominates the US market, appeared in 2000 but was used in less than 1% of surgeries a decade later—but their popularity has exploded in recent years. Robotic surgery now accounts for 22% of all US surgeries, with its application to different types of surgeries rapidly expanding.

Ultimately, robotic surgery may replace human surgeons, at least in part. A new presentation from Johns Hopkins showed that AI-equipped surgery robots could learn to do some surgical procedures automatically after watching surgeons perform.

Even now, existing robots may enhance productivity by reducing the physical demands of surgery. Unlike traditional procedures, which force surgeons to stand for hours, robotic surgery can be performed from the comfort of a chair.

The robot’s control panels typically sit in the operating room but can be anywhere with an internet connection. At least one patient needing a rare procedure has already undergone surgery from an expert half a world away.

The robotic technique also helps experienced surgeons train students and residents. The system features dual consoles, allowing a teacher to guide a resident through the procedure in real time.

“There are actually two consoles, one that the surgeon uses and a duplicate in a different area of the room,” Kim says in a release. “This lets your residents or anyone else you’re training sit in the same position and see exactly what the surgeon sees. If you need a second qualified surgeon, they can also work on the robot simultaneously.

“At the end of every case, the robot sends information to the apps on our phones that track all the time spent by the student, the teaching surgeon, and how many moves each one made. That information helps you gradually give trainees more autonomy and track our progress so that we can constantly improve our techniques.”

Assessing Long-Term Impact and Limitations

As with any new surgical technique, questions remain about long-term outcomes and cost-effectiveness. The Rutgers team is studying their results and plans to publish their findings to contribute to the growing evidence surrounding robotic reconstruction.

“We’re carefully tracking our outcomes and plan to publish a case series once we have more data,” says Kim in a release. “It’s crucial that we demonstrate not just the feasibility of this approach, but its long-term benefits for patients.”

While the robotic technique shows promise, both surgeons emphasize that it’s not appropriate for every patient. For example, the robot’s ability to cut less skin provides no advantage in procedures where surgeons must transfer a significant amount of skin to the repair site.

Careful patient selection and thorough discussion of all reconstructive options remain important factors in the decision-making process.

“In the end, it’s all about providing our patients with the best possible results and experience,” says Lee in a release. “If we can achieve that with smaller scars and faster recoveries, that’s a win for everyone involved.”

Photo caption: Surgeons Edward Lee and Danbee Kim use this surgical robot to speed healing and minimize scarring from breast reconstruction.

Photo credit: Jeff Arban/Rutgers