title: The influence of subfascial transaxillary breast augmentation in axillary lymphatic drainage patterns and sentinel lymph node detection.
abstract: BACKGROUND
  The transaxillary approach plays a useful role for breast augmentation due to scar placement in a less visible position. However, the future impact of the procedure on the lymphatic drainage patterns and sentinel lymph node (SLN) detection remains controversial. To date, no information is available regarding the feasibility of SLN identification in patients with previous transaxillary breast augmentation (TBA).
  
  
  METHODS
  Twenty-six patients underwent primary TBA. Mean follow-up was 8.3 months. All patients were submitted to lymphoscintigraphy (LSG), with a dose of 0.1 mCi 99m-technetium-labeled dextran 1 week before (preop-LSG) and 10 days (Po10 days-LSG) after TBA.
  
  
  RESULTS
  Preop-LSG was successful in all patients. Mean number of SLN detected was 2 per patient (range, 1 to 4) in the right axilla and 2.2 (range, 1 to 5) in the left. In Po10 days-LSG, SLN detection was successful in 92.3%. Mean number of SLN detected was 2.3 per patient (range, 0 to 7) in the right axilla and 1.8 (range, 0 to 6) on the left. Two patients (7.6%) failed to reveal the accumulation of radioactivity in Po10 days-LSG. Comparing bilaterally, in the number of SLN detected (P = 0.838) and the SLN uptake (P = 0.067) between Preop-LSG and Po10 days-LSG, no significant differences were observed. No major complication was noted.
  
  
  CONCLUSIONS
  The initial data illustrate that SLN detection in the setting of prior TBA is feasible in a great part of patients. Additional long-term studies are necessary to investigate the accuracy of SLN biopsy in subgroups of breast cancer patients with previous breast implants.
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.forename: Cláudia
authors.initials: C
authors.lastname: Aldrighi
authors.forename: Carla
authors.initials: C
authors.lastname: Ono
authors.forename: Carlos
authors.initials: C
authors.lastname: Buchpiguel
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.forename: Klaus
authors.initials: K
authors.lastname: Fells
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arruda
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Aldrighi
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001365:Axilla / Q000000981:diagnostic imaging / Q000601:surgery; D018427:Breast Implants; D015331:Cohort Studies; D003911:Dextrans; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008196:Lymph / Q000502:physiology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D016462:Mammaplasty / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D020034:Silicone Gels; D017556:Technetium Compounds
chemical_list: D003911:Dextrans; D020034:Silicone Gels; D017556:Technetium Compounds