<p>Robot-assisted breast reconstructive surgery has emerged as an evolving application of minimally invasive and robotic surgery in breast and reconstructive practice. However, its global research landscape, collaborative patterns, intellectual structure, and thematic evolution have not been systematically characterised. This study aimed to map the development, research hotspots, and emerging trends in robot-assisted breast reconstructive surgery through bibliometric and visualisation analyses, while recognising its close clinical overlap with robotic nipple-sparing mastectomy and immediate reconstruction. Publications on robot-assisted breast reconstructive surgery published between 1 January 2005 and 31 December 2025 were retrieved from the Web of Science Core Collection (WoSCC). A relatively sensitive retrieval strategy was used first, followed by manual screening, to capture reconstructive literature developing in close association with robotic nipple-sparing mastectomy and related oncologic–reconstructive procedures. After screening, 218 publications were included. Bibliometric and visualisation analyses were performed using Bibliometrix, CiteSpace, VOSviewer, and Scimago Graphica to evaluate annual publication trends, contributions by countries, institutions, authors, and journals, as well as co-citation networks, keyword co-occurrence, clustering, burst detection, and thematic evolution. A total of 218 publications, including 164 original articles and 54 reviews, were identified. Annual output remained limited before 2018 but increased markedly thereafter. China, Korea, and the United States were the most active contributors, while Changhua Christian Hospital and Yonsei University were the leading institutions. Plastic and Reconstructive Surgery was the most productive and most locally cited journal. Lee J and Park HS were the most productive authors, whereas Lai HW, Selber JC, Toesca A, and Sarfati B emerged as key collaborative and intellectual hubs in the field. Major research themes included oncologic safety, nipple-sparing mastectomy, immediate breast reconstruction, flap reconstruction, donor-site morbidity, free flap, and robotic microsurgery. Trend analyses indicated a shift from early feasibility-focused studies toward more specialised concerns involving oncologic safety, advanced autologous reconstruction, and microsurgical refinement. Research on robot-assisted breast reconstructive surgery has expanded rapidly in recent years and is increasingly concentrated in a limited number of leading countries, institutions, authors, and journals. The field appears to have evolved from early technical feasibility studies toward a more specialised and clinically connected stage of scholarly attention, with growing emphasis on oncologic safety, nipple-sparing mastectomy, immediate reconstruction, donor-site optimisation, and advanced microsurgical or autologous applications. This study provides a structured overview of the global development and thematic evolution of robot-assisted breast reconstructive surgery and may serve as a useful reference for future clinical research and academic collaboration.</p>