Four studies presented at the 27th Annual Meeting of the American Society of Breast Surgeons in Seattle this week advance a consistent theme: breast cancer patients across surgical categories benefit from approaches that reduce intervention burden while preserving, or in some cases improving, outcomes. The research spans post-operative exercise, surgical decision-making for young women, robotic mastectomy technique, and radiation de-escalation after sentinel node surgery omission.
HotSpot Take
Four new studies from the American Society of Breast Surgeons (ASBrS) Annual Meeting in Seattle challenge long-held assumptions about breast cancer surgical care. Findings show that intensive post-operative resistance training benefits patients across all surgical categories, that mastectomy offers no survival advantage over breast-conserving surgery for young women with high-risk disease receiving neoadjuvant therapy, that robotic nipple sparing mastectomy matches open surgery on safety and effectiveness while earning FDA clearance, and that omitting sentinel lymph node surgery does not drive escalation of radiation therapy. Taken together, the studies build an evidence base for care that is more tailored, less invasive, and more centered on individual patient needs.
Intensive Resistance Training Delivers Gains Across Surgical Groups
Post-operative exercise programs for breast cancer survivors are moving from survivorship support toward standard-of-care consideration, according to new research.
A three-month supervised resistance training program produced significant improvements in strength, mobility, and body composition in post-operative breast cancer patients, regardless of whether they had undergone lumpectomy, mastectomy, or axillary lymph node dissection (ALND), according to research from Allegheny Health Network.
The study analyzed pooled data from 197 breast cancer survivors who completed the program at Allegheny Health Network’s Exercise Oncology and Resiliency Center in Pittsburgh. Participants were stratified by surgical type: 85 treated with mastectomy and 112 with lumpectomy, and 26 who underwent ALND versus 171 who did not.
“Traditional guidelines question how soon women treated for breast cancer can exercise and how much weight they can safely lift, particularly in mastectomy and ALND patients who have had extensive surgery,” said lead researcher Colin Champ, M.D., Associate Professor at Allegheny Health Network and a Certified Strength and Conditioning Specialist. “However, by the third week, most women in our program could deadlift — raise from floor to hip level — 100-pound weights and by the program’s conclusion many were lifting 200-pound loads. The gains on all program parameters remained similar across lumpectomy, mastectomy and ALND status as the program demands intensified.”
The program used dose-escalating compound movements modeled on early professional athletic training, a far more demanding approach than most prior resistance exercise studies in breast cancer populations. Pre- and post-program measurements included body mass index, muscle mass and body fat percentage via bioimpedance analysis, functional movement screening (FMS), hand grip strength, Godin activity surveys, Y-balance testing, and standardized weightlifting assessments across four movement patterns: split squat, dumbbell bench press, dumbbell rows, and hex bar deadlifts.
All patient groups showed significant pre- to post-program improvements across all measures. Mastectomy and lumpectomy groups demonstrated comparable gains in BMI, muscle mass percentage, body fat percentage, FMS score, and composite weight loads lifted. Older age and receipt of radiation therapy were associated with lower baseline FMS scores; baseline clinical and treatment factors accounted for 18.5% of variability in initial FMS scores. Critically, those same factors accounted for only 6.7% of variability in program improvement, indicating that functional gains were driven primarily by the exercise intervention rather than surgical or treatment history. ALND patients trended lower only on the functional Y-balance test, and mastectomy patients showed a non-significant trend toward lower bench press load improvement, a finding researchers note did not affect overall conclusions.
“Women treated for breast cancer may have been subjected to more than a year of physically and psychologically traumatic therapies. They lose range of motion and muscle mass. This study demonstrates that even those treated with extensive surgeries can make enormous gains in a few months and achieve the same or greater strength, motion and muscle mass than prior to surgery.” — Colin Champ, M.D., Allegheny Health Network
“Women treated for breast cancer may have been subjected to more than a year of physically and psychologically traumatic therapies,” said Dr. Champ. “They lose range of motion and muscle mass. This study demonstrates that even those treated with extensive surgeries can make enormous gains in a few months and achieve the same or greater strength, motion and muscle mass than prior to surgery. They do not have to wait years to improve function and lifestyle.”
Researchers concluded that exercise should be considered not just a survivorship component but a standard of care element for breast cancer patients.
Mastectomy Offers No Survival Advantage for Young Women After Neoadjuvant Therapy
Young women with locally advanced, high-risk breast cancer were significantly more likely to undergo mastectomy than older women with similar disease in an analysis of I-SPY2 clinical trial data, but more extensive surgery provided no benefit in overall survival or local recurrence when controlling for tumor characteristics and treatment response.
The study, presented by lead researcher Jennifer Tseng, M.D., Associate Clinical Professor and Medical Director of Breast Surgery at City of Hope Orange County, examined 1,737 patients enrolled in the I-SPY2 trial from April 2010 to June 2022. Of these, 698 (40.2%) were age 45 or younger, and 1,039 (59.8%) were older than 45. All had clinical stage II-III breast cancer with high-risk MammaPrint scores and received neoadjuvant systemic therapy before surgery.
Rates of breast-conserving surgery were substantially lower in younger patients (36.8%) compared with older patients (48.5%), despite similar tumor receptor subtypes, nodal categories, histologic grade, and residual cancer burden class between the two groups. Younger patients did present with measurably greater MRI functional tumor volumes, both before neoadjuvant therapy (32.88 cm³ vs. 23.02 cm³) and after (4.60 cm³ vs. 3.22 cm³), suggesting greater initial disease burden in the younger cohort. The study followed patients for a median of 5.24 years, with 200 overall survival events and 133 locoregional recurrence events across both age groups. On multivariate analysis, there were no significant differences in overall survival or locoregional recurrence-free interval for younger patients undergoing breast-conserving surgery versus mastectomy. One notable exception: within the hormone receptor-positive, HER2-negative subtype specifically, breast-conserving surgery was associated with better locoregional recurrence-free interval in younger patients, a finding the authors indicate warrants further investigation.
“Unfortunately, despite similar recurrence and survival rates for comparable disease, younger patients more often undergo mastectomy, which excises all breast tissue, rather than breast conserving surgery, which removes only the tumor along with a surrounding margin of healthy tissue and has lower rates of complications and morbidity along with higher patient satisfaction,” said Dr. Tseng.
“Younger women and some of their physicians may equate more extensive treatment with long-term survival when this may not be the case.” — Jennifer Tseng, M.D., City of Hope Orange County
“Younger women and some of their physicians may equate more extensive treatment with long-term survival when this may not be the case,” she added.
The research also notes that neoadjuvant systemic therapy may allow patients who would otherwise proceed directly to mastectomy to become candidates for breast-conserving surgery by reducing tumor volume and altering disease profile before surgery. The authors emphasized the importance of accessible, up-to-date information for both patients and clinicians. HealthTech HotSpot has previously covered related breast surgery de-escalation research from prior ASBrS annual meetings.
“More research is needed to identify the appropriate treatment protocols for younger patients,” said Dr. Tseng. “Additionally, existing information may not be readily accessible to patients and the complete medical community involved in their care. For this population, in particular, communications and information sharing are powerful cancer care tools.”
Robotic Nipple Sparing Mastectomy Earns FDA Clearance After Trial Confirms Safety
The first robotic surgical platform cleared by the FDA for use in nipple sparing mastectomy (NSM) procedures has demonstrated safety and effectiveness comparable to conventional open surgery in a prospective, multicenter randomized controlled trial, with researchers noting additional potential advantages for both patients and surgeons.
The study, conducted under FDA Investigational Device Exemption G220319, enrolled 74 patients at 14 U.S. sites between August 2023 and December 2025. Participants met accepted criteria for NSM (surgeries that remove all breast tissue while preserving the nipple-areolar complex and most breast skin) and were randomized to robotic NSM using the da Vinci Single Port (SP) system or open NSM. The trial included 65 robotic procedures (38 therapeutic, 27 prophylactic) and 66 open procedures (38 therapeutic, 28 prophylactic).
The study found no statistically significant differences between the two approaches in post-operative event rates at 42 days, positive surgical margin rates, final pathology results, nipple-areolar complex viability, or hospital stay. Serious adverse events at 42 days occurred in 3 robotic patients (8.1%) compared to 8 open patients (21.6%), with no device-related serious adverse events in the robotic group. No robotic patients required conversion to open surgery. Unplanned reoperations occurred in 2 robotic patients (5.4%) versus 8 open patients (21.6%). Blood loss was lower for robotic NSM. Surgical duration was longer for robotic NSM at 141.6 minutes versus 83.9 minutes for open procedures; reconstruction time followed a similar pattern at 79.7 minutes for robotic versus 62.5 minutes for open. Both differences were attributed to the learning curve associated with a new technique.
At six months, BREAST-Q patient-reported outcome scores showed more favorable changes in the robotic group across three domains: sexual well-being (-7.2 vs. -11.6), satisfaction with breasts (-0.6 vs. -6.3), and physical well-being of the chest (-9.1 vs. -16.6). None of these differences reached statistical significance, and researchers note the trial’s early conclusion prior to full planned enrollment may limit the power to detect such differences. Participants will continue to be followed through the full five-year protocol, and longer-term BREAST-Q data may clarify the patient experience picture.
“While for eligible women, nipple sparing surgeries typically provide multiple benefits,” said lead researcher Katherine Kopkash, M.D., Director of Oncoplastic Breast Surgery at Endeavor Health and Clinical Professor of Surgery at University of Chicago Pritzker School of Medicine, “in our study, surgeries performed with the da Vinci Single Port robotic system demonstrated improved patient satisfaction on BREAST-Q assessment compared to conventional procedures.”
Robotic NSM also addresses ergonomic strain on surgeons. Open NSM procedures require sustained positioning that contributes to fatigue and musculoskeletal discomfort. “Painful posture is a major issue for physicians performing frequent open NSM procedures and may also hamper their ability to manage a full surgical schedule,” Dr. Kopkash noted.
The trial concluded prior to completing planned enrollment when the da Vinci SP received FDA 510(k) clearance for robotic NSM applications, making it the first robotic platform in the U.S. cleared for this use. Study participants will continue to be followed through the full five-year protocol.
“A more comfortable position with enhanced visualization enables better surgeries,” said Dr. Kopkash. “Potential patient benefits may be significant. We eagerly await long-term data from these promising clinical trials.”
Sentinel Node Surgery Omission Does Not Drive Radiation Escalation
Lumpectomy patients whose sentinel lymph node (SLN) surgeries were omitted in accordance with SOUND and INSEMA trial criteria were no more likely to receive escalated radiation therapy than patients with similar tumors who underwent SLN surgery, according to a retrospective study at Mayo Clinic in Rochester, MN. In fact, patients without SLN surgery were more likely to receive partial breast irradiation or no radiation at all.
The study included 999 women age 50 and older with 1,016 breast cancers treated with breast-conserving surgery between January 2020 and August 2025. All had cT1 or T2, ER+/HER2-negative tumors consistent with the patient population in the SOUND and INSEMA trials. SLN surgery was performed in 66.8% of cases, with omission in 33.2%. Over the study period, SLN surgery rates declined significantly, from 74.5% in 2020 to 49.1% in 2025.
Among patients who did not undergo SLN surgery, 51.0% received partial breast irradiation (PBI), 27.5% received no radiation, and 21.5% received whole breast irradiation (WBI), compared to a WBI rate of 50.9% in the SLN surgery group. In contrast, patients who underwent SLN surgery and were node-negative received PBI and WBI at roughly equal rates of approximately 46% each; 95.2% of node-positive patients in that group received WBI.
The study also examined radiation patterns by age subgroup, a clinically relevant distinction. Among patients aged 50 to 69 with SLN surgery omitted, 11.1% also had radiation omitted, compared to 30% in patients over age 70. For those in the 50-to-69 group who did receive radiation, PBI was the most common choice at 75.0%. In the over-70 group with SLN omission, PBI (48.6%) and radiation omission (30%) together accounted for nearly 80% of cases, while WBI was used in only 21.4%. The pattern suggests that multidisciplinary teams are calibrating radiation decisions to individual patient age and risk profile alongside surgical decisions.
“The possibility that a decrease in one treatment modality will lead to an increase in another treatment modality is a real-world concern,” said study researcher Matthew Hager, M.D., breast surgical oncology fellow at Mayo Clinic in Rochester, MN. “Today a growing number of well-selected patients with low-risk breast cancer are being spared SLN surgeries. Our study is one of the first to examine radiation therapy in the setting of nodal surgery omission.”
“This suggests that our multidisciplinary care team is working together in implementing advances in management and integrating information from their individual medical specialties to optimize and personalize patient care,” he added.
“Today many patients with low-risk disease are being offered both less surgery and less radiation, which ultimately results in more personalized patient care.” — Judy Boughey, M.D., Mayo Clinic
Senior study author Judy Boughey, M.D., Chair of the Division of Breast and Melanoma Surgical Oncology at Mayo Clinic in Rochester, connected the finding to the broader trend toward individualized low-risk breast cancer care: “Today many patients with low-risk disease are being offered both less surgery and less radiation, which ultimately results in more personalized patient care.”
The findings align with a wider pattern of surgical and therapeutic de-escalation in appropriately selected breast cancer patients, one that HealthTech HotSpot has tracked across multiple research presentations at recent ASBrS annual meetings.
Evidence Base Builds for Patient-Centered Surgical Care
Taken together, the four studies presented at the 27th ASBrS Annual Meeting in Seattle reflect a maturing body of evidence pointing in a consistent direction: that breast cancer patients across surgical categories, age groups, and risk profiles can tolerate and benefit from approaches that were once considered too aggressive (intensive exercise) or too conservative (less surgery and less radiation). The American Society of Breast Surgeons, whose annual meeting runs through May 4, is the primary professional organization for surgical breast care specialists in the United States.
The research carries practical implications for multidisciplinary care teams. Neoadjuvant systemic therapy may open breast-conserving options for young women previously steered toward mastectomy. Robotic NSM now has an FDA-cleared platform with mounting clinical evidence to support wider adoption. Radiation oncologists and breast surgeons can continue to de-escalate both modalities in well-selected patients. And exercise oncology, long positioned as supplemental to survivorship care, may be ready to move into standard treatment protocols.
Early-stage localized breast cancer carries a greater than 99% five-year survival rate, according to the American Cancer Society, a statistic that gives added weight to research focused on quality of life, function, and avoidance of unnecessary intervention alongside survival outcomes.
— This original article was created with AI support.
