Sentinel lymph node biopsy in the augmented breast: role of the transaxillary subpectoral approach

Given the use of sentinel lymph node biopsy for breast cancer staging, some plastic surgeons may be hesitant to offer patients a transaxillary approach to augmentation for fear of disrupting the lymphatic drainage of the breast. Dissection within the axilla theoretically compromises the normal drainage of the breast tissue to the axillary lymph node basin, a critical element in the procedure of sentinel lymph node mapping. We present a case report in which successful sentinel lymph node biopsy was performed after transaxillary subpectoral augmentation mammaplasty. Remaining high and anterior in the axilla within the subcutaneous plane is crucial in minimizing any compromise of normal lymphatic drainage. In addition, it is generally agreed that subpectoral placement of the implant generates less distortion in the mammographic evaluation of the breast than does a subglandular implant. As a result, the transaxillary subpectoral method of augmentation may be one of the most amenable techniques with regard to screening and diagnosis of breast cancer. (Aesthetic Surg J 2003;23:184-187.).