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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Immediate microsurgical breast reconstruction and simultaneous sentinel lymph node dissection: issues with node
Michael S Curtis1, Brian Arslanian, Salih Colakoglu
1Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York, USA.
Journal of Reconstructive Microsurgery
|July 1, 2011
Summary
Sentinel lymph node dissection (SLND) during mastectomy with microsurgical reconstruction is safe. Completion axillary lymph node dissection (ALND) for positive nodes showed no adverse effects, favoring internal mammary vessels for reconstruction.
Area of Science:
- Oncology
- Plastic Surgery
- Surgical Oncology
Background:
- Sentinel lymph node dissection (SLND) is increasingly used during mastectomy to reduce lymphedema risk.
- Microsurgical breast reconstruction is often performed simultaneously with mastectomy and SLND.
- Completion axillary lymph node dissection (ALND) may be necessary for positive SLND results, posing potential risks to microsurgical reconstructions.
Purpose of the Study:
- To evaluate the safety and potential risks of completion ALND in patients who underwent immediate microsurgical breast reconstruction and SLND.
- To identify optimal recipient vessel choices for microsurgical reconstruction in patients requiring subsequent ALND.
Main Methods:
- A prospective database of patients undergoing microsurgical breast reconstruction (2004-2010) was reviewed.
- Patients with immediate reconstruction and SLND were identified.
- Chart review was used to ascertain management of positive lymph node status and any adverse effects.
Main Results:
- Of 440 immediate reconstructions, 110 patients had SLND, with 16 (14.55%) having positive nodes.
- All 16 patients with positive SLND had internal mammary recipient vessels for their free tissue transfer.
- Seven patients underwent intraoperative completion ALND, and nine had staged completion ALND, with no reported adverse effects.
Conclusions:
- Simultaneous mastectomy, SLND, and microsurgical breast reconstruction can be performed safely.
- Internal mammary vessels are preferred recipient vessels for microsurgical reconstruction when completion ALND may be required.
- Using thoracodorsal anastomosis carries a risk of vessel injury and flap loss during completion ALND.
