Bilateral axillary and internal mammary drainage in breast cancer without prior surgery during sentinel node mapping

Lymphatic drainage outside the ipsilateral axilla in breast cancer is discovered in as many as 25% of all sentinel lymph node procedures and it is evidenced by lymphoscintigraphy. Contralateral axillary drainage is a rare clinical situation, mostly if there is not prior breast surgery, but this situation is extremely exceptional if we also found internal mammary chain drainage. We have not found such a case published in literature. This atypical finding is source of doubts because it could have clinical implications in the management of patients. We present a woman just diagnosed of breast carcinoma with hot nodes in bilateral axillary and ipsilateral internal mammary chain lymph nodes, shown by preoperative lymphoscintigraphy. We review published cases with contralateral axillary drainage, which enhance the role of scintigraphic procedure in such cases and show induced controversies in selecting the most adequate management.