At the American Society of Breast Surgeons (ASBrS) 27th Annual Meeting, investigators presented new findings on breast cancer surgery, postoperative recovery, and radiation treatment planning. Among the many sessions, several studies were presented during a media briefing earlier this month and are highlighted in this news overview.
Young Age Alone May Not Warrant Mastectomy After Neoadjuvant Therapy
Young women with high-risk breast cancer who underwent breast-conserving surgery after neoadjuvant systemic therapy had outcomes similar to those who underwent mastectomy, according to findings from the I-SPY2 clinical trial.1
The distinction is clinically important because mastectomy and other more extensive surgical approaches can carry long-term effects, including loss of chest wall sensation, body image and self-esteem concerns, effects on sexual well-being and arousal, mobility issues, and increased financial burden.
The study, presented by Jennifer Tseng, MD, Associate Clinical Professor and Medical Director of Breast Surgery for City of Hope Orange County, evaluated surgical management among 1,737 patients with clinical stage II/III breast cancer treated in I-SPY2 from April 2010 to June 2022. Of these patients, 40% were aged 45 or younger and 60% were older than 45. Patient and tumor characteristics, as well as axillary surgery type, were similar between the age groups.
Jennifer Tseng, MD
Women aged 45 or younger had lower rates of breast-conserving surgery than older patients: 36.8% vs 48.5%, respectively. However, use of breast-conserving surgery increased over the study period, suggesting that surgical practice may be shifting for younger patients.
Among patients aged 45 years or younger, overall survival did not differ by breast surgery type, with similar findings for locoregional-free interval.
“Tumor biology and response to medical therapy make significant differences, but the choice of breast surgery does not,” Dr. Tseng said.
The findings support a more individualized approach to surgical decision-making after neoadjuvant systemic therapy. Young age alone, Dr. Tseng concluded, should not be considered a reason to recommend mastectomy.
Resistance Training
A supervised 12-week resistance training program produced meaningful functional gains in breast cancer survivors, including those who had undergone mastectomy or axillary lymph node dissection, groups for whom upper-extremity loading has historically been restricted.2
The study was presented by Colin E. Champ, MD, CSCS, of the Allegheny Health Network Cancer Institute, and included 197 women aged 20 to 89 with a history of ductal carcinoma in situ or invasive breast cancer. Participants completed a dose-escalated resistance training program supervised by certified strength and conditioning specialists.
Colin E. Champ, MD, CSCS
Of the women included in the analysis, 112 had undergone lumpectomy and 85 had undergone mastectomy. Axillary lymph node dissection was less common, occurring in 26 patients. Baseline functional movement and Y-Balance scores (a measure of dynamic balance and limb symmetry) were similar across surgical groups.
After 12 weeks, participants across the full cohort improved their functional movement scores, and average composite resistance load (total weight lifted across exercises) increased by more than 2,000 lbs. Significant improvements were also seen in grip strength, balance, and body composition. These gains were seen regardless of whether patients had undergone mastectomy, lumpectomy, or axillary lymph node dissection.
“Functional gains are independent of surgical modality,” Dr. Champ said. He added that dose-escalated resistance training was safe and improved mobility and strength across treatment groups.
For surgeons counseling patients after breast cancer surgery, the findings offer practical reassurance: surgical extent did not appear to limit patients’ ability to benefit from a structured, supervised resistance training program.
Robotic Nipple-Sparing Mastectomy
In a select group of women with early-stage breast cancer, robotic nipple-sparing mastectomy using showed an early safety profile comparable to the traditional open approach, according to findings presented by Katherine Kopkash, MD, FACS, Director of Oncoplastic Breast Surgery at Endeavor Health and Clinical Professor of Surgery at the University of Chicago Pritzker School of Medicine.3
Eligible patients had early-stage breast cancer and were candidates for nipple-sparing mastectomy with implant-based reconstruction. The trial used conservative criteria, including BMI under 30, breast cup size C or smaller, and grade 1 or 2 breast ptosis.
Katherine Kopkash, MD, FACS
The prospective, multicenter randomized trial compared robotic vs open nipple-sparing mastectomy at 14 U.S. sites, with procedures performed by 23 surgeons. The study’s primary outcomes included conversion from robotic to open surgery, adverse events at 42 days, and positive surgical margin rates. Secondary outcomes included operative time, estimated blood loss, nipple-areolar complex viability, patient-reported outcomes measured by BREAST-Q (ie, an outcomes tool measuring measuring factors such as quality of life and satisfaction with breast surgery), and surgeon ergonomic workload.
The robotic approach took longer. Mean nipple-sparing mastectomy procedure time was 141.6 minutes with robotic surgery vs 83.9 minutes with open surgery and reconstruction time was also longer: 79.7 vs 62.5 minutes. However, there were no conversions from robotic to open surgery.
Robotic surgery was associated with lower estimated blood loss: 60.3 vs 97.8 mL with open surgery. Nipple-areolar complex preservation at 42 days was similar between groups, as were unplanned reoperations and positive surgical margin rates. Positive surgical margins occurred in 16.2% of patients in both arms, and no cancer recurrences were reported in either group at 6 months.
Serious adverse events at 42 days were numerically higher in the open surgery group, although the difference was not statistically significant. BREAST-Q results also favored robotic surgery in several domains, including sexual well-being, satisfaction with breasts, and physical well-being of the chest, but those differences were not statistically significant.
“These findings support the safe adoption of robotic nipple-sparing mastectomy in carefully selected patients following structured training, and in experienced centers,” Dr. Kopkash said.
Longer follow-up will be needed to better define oncologic outcomes, but the early data suggest the technique can be performed safely in selected patients and at experienced centers.
Sentinel Lymph Node Surgery Omission
At Mayo Clinic Rochester, omission of sentinel lymph node surgery increased over time among selected patients with low-risk breast cancer, without a corresponding increase in radiation therapy or whole-breast irradiation.4
The single-institution retrospective review was presented by Matthew G. Hager, MD, and evaluated patients treated from January 1, 2020, to August 1, 2025. Dr. Hager is a Breast Surgical Oncology Fellow at Mayo Clinic in Rochester, Minnesota.
Matthew G. Hager, MD
Eligible patients were women aged 50 or older with cT1/cT2 cN0 M0, estrogen receptor–positive/HER2-negative breast cancer treated with upfront breast-conserving surgery.
Investigators compared patients who underwent sentinel lymph node surgery with those who did not, then assessed radiation treatment patterns, including whole-breast irradiation, partial-breast irradiation, or omission of radiation.
The review included 1,016 breast cancers in women aged 50 or older with low-risk, ER-positive, HER2-negative disease treated with lumpectomy. Sentinel lymph node surgery was omitted in 337 cases and performed in 679 cases. Omission was used more often in patients with lower-risk features, including older age, smaller tumors, lower tumor grade, and lower Ki67.
Use of sentinel lymph node surgery omission increased over the study period, from 25.5% of eligible patients in 2020 to 50.9% in 2025. The approach was adopted earliest and most often in patients aged 70 or older, but it also became more common among patients aged 50 to 69, with uptake increasing after the SOUND trial was incorporated into practice.
Importantly, patients who did not undergo sentinel lymph node surgery were not more likely to receive intensified radiation. Instead, they had lower rates of whole-breast irradiation and were more likely to receive partial-breast irradiation or omit radiation altogether compared with those who underwent sentinel lymph node surgery.
“With a multidisciplinary team approach, we are successfully de-escalating axillary surgery in appropriately selected patients without escalating radiation,” Dr. Hager said.
For clinicians, the message was practical: de-escalating axillary surgery does not have to mean compensating with more radiation, provided the treatment plan is coordinated across the multidisciplinary team.
DISCLOSURES: For full disclosure information for all study authors, visit breastsurgeons.org.
REFERENCES
1. Tseng J, et al:. Surgical management of young women with high-risk breast cancer receiving neoadjuvant systemic therapy. Presented at the American Society of Breast Surgeons(ASBrS)Press Briefing. April 23, 2026.
2. Hernandez LC, et al: Functional outcomes for breast cancer survivors following an intense resistance training program based on surgical management of the breast and axilla. ASBrS Press Briefing. April 23, 2026.
3. Kopkash K: A prospective, multi-center randomized controlled trialof the da Vinci SP® Surgical System vs open surgery in nipple sparing mastectomy. Presented at the ASBrS Press Briefing. April 23, 2026.
4. Hager MG, et al: Impact of omission of sentinel lymph node surgery on radiation treatment in patients age 50 and older with breast cancer treated with lumpectomy. Presented at the ASBrSs Virtual Press Briefing. April 23, 2026.
