By Lauren Johnson

Alabama breast surgeon, Katelin Holmes, DO became the first doctor in the United States to perform a laparoscopic, FDA-approved nipple-sparing mastectomy. Holmes is a breast surgical oncologist at Thomas Hospital in Fairhope, and is a UAB clinical assistant professor.

Through this new, minimally invasive technique, patients will have a smaller scar after surgery. Studies show that it causes less tissue trauma than open surgery and it preserves nerve pathways to the skin and nipple, keeping them intact.

“We’re able to use the small incision laterally, near the patient’s side of their torso rather than on the breast directly, similar to other laparoscopic minimally invasive surgeries that are now standard for things like gallbladder surgery, hernia repair, and appendectomies, to name a few. It’s the same kind of principles and technology, but applied to the breast,” Holmes said.

When Holmes heard about the laparoscopic technique becoming more accepted for mastectomies internationally, she seized the opportunity to receive training with a desire to bring the technique back to the U.S. She contacted Applied Medical, a global medical device company that makes the laparoscopic system called GelPort, and she was selected as one of five surgeons in the first group from the U.S. to go to Amsterdam for training.

“There were surgeons from all over the world – from Spain, Italy, France, Taiwan – so they were able to combine all of their international experience and training models to give us all of their expertise in one sitting,” Holmes said.

She and the other surgeons received hands-on training through a cadaver course, learning from the experts in the field. On April 18, 2025, Holmes became the first surgeon in the U.S. to perform a laparoscopic nipple-sparing mastectomy. Since then, she’s completed three more, all with successful results.

“It was a huge honor to be the first,” she said. “I was thrilled, but most of all I felt it was so important to have someone advocate for women in Alabama; to say we have to do things through the best approach possible for women with breast health issues, whether that’s breast cancer or prophylactic mastectomies. I feel strongly, as someone who grew up in a small town, that even women in rural communities deserve top-notch care.

“With the GelPort surgery, a lot of women are able to still feel their breast area, whereas that’s typically not the case with open surgery. In addition to having a smaller scar, this technique saves the nipple and skin, so it preserves how a woman looked before the surgery.”

The surgery is also expected to shorten recovery times and decrease complications. And any patient who is a candidate for a traditional nipple-sparing mastectomy will likely be a candidate for this procedure. Some limitations depend on the shape and size of the patient’s breast, as well as how close the cancer cell is to the nipple.

Holmes wants to ensure that clinicians are always pushing the envelope in breast care. She’s encouraged to see more surgeons adopt this new technique, and is looking forward to seeing what advancements will come in the future. There are currently clinical trials ongoing to test robotic-assisted nipple-sparing mastectomies.

“In addition to this and other surgical advancements, we’re beginning to personalize every treatment plan to the patient and their exact cancer biology,” Holmes said. “Now, it’s not a one-size-fits-all for breast cancer, whether that means minimally invasive surgery or personalized decision making about her tumor’s DNA and what that means for chemo or genetic testing. Every woman deserves to be at a treatment center where she is at the center and forefront of every decision.”