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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
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Axillary Lymph Node Dissection Through a Separate Incision Does Not Increase Rates of Breast Cancer-Related
Jennifer Wang1, Jenny Chen1, Thomas Amburn2
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Annals of Surgical Oncology
|February 10, 2026
Summary
Axillary lymph node dissection (ALND) through a separate incision does not increase breast cancer-related lymphedema (BCRL) risk compared to the mastectomy incision. Oncologic safety remains paramount in surgical technique selection.
Area of Science:
- Oncology
- Surgical Oncology
- Lymphedema Research
Background:
- Axillary lymph node dissection (ALND) is a standard breast cancer treatment, carrying a 20-30% lifetime risk of lymphedema.
- The surgical approach for ALND (mastectomy vs. separate incision) may influence lymphatic disruption and subsequent lymphedema rates, though this remains unclear.
Purpose of the Study:
- To investigate whether the incision site for axillary lymph node dissection (ALND) impacts the incidence of breast cancer-related lymphedema (BCRL).
Main Methods:
- Retrospective chart review of 1,036 patients undergoing mastectomy and ALND between 2017-2020.
- Patients were stratified based on ALND approach: via mastectomy incision or separate axillary incision.
- Breast cancer-related lymphedema (BCRL) development, identified by ICD-10 codes, was the primary outcome measure.
Main Results:
- No significant difference in BCRL rates was observed between the two ALND approaches (29% for separate incision vs. 30% for mastectomy incision, p=0.77).
- Multivariable analysis indicated that ALND via a separate incision did not significantly increase the odds of developing lymphedema (OR 0.89; 95% CI 0.65-1.21; p=0.45).
- Median time to lymphedema diagnosis was 15 months across both groups.
Conclusions:
- Performing axillary lymph node dissection (ALND) through a separate axillary incision does not lead to significantly higher rates of breast cancer-related lymphedema (BCRL) compared to the mastectomy incision.
- Prioritizing oncologic safety should guide the choice of lymph node retrieval technique in breast cancer surgery.
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