The first robotic mastectomy with immediate breast reconstruction was described by Toesca et al. in 2017 [1]. Toesca et al. developed this new technique to overcome some of the limitations of endoscopic nipple-sparing mastectomy with the best surgical vision and articulated arms for mastectomy. With a small incision in the lateral chest wall, breast reconstruction with implant has been developed accordingly due to the ease of implantation in comparison to autologous tissue transfer and good aesthetic outcome with good patient selection. In addition to mastectomy, the assistance of robot in dissecting the subpectoral plane, suturing the acellular dermal matrix to support the lower pole of breast implant, even capsulotomy and partial capsulectomy was also introduced. Patients with good candidates are with non-ptotic, small/moderate sized breasts in early stage breast cancer without requirement of post-mastectomy radiotherapy. With proper patient selection, robot-assisted nipple-sparing mastectomy and implant-based reconstruction presents as a cutting edge of aesthetic breast cancer surgery, both cancer resection and aesthetic reconstruction outcome with invisible scar.