The influence of subfascial transaxillary breast augmentation in axillary lymphatic drainage patterns and sentinel lymph node detection.
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.
Munhoz
Alexandre Mendonça
AM
Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. munhozalex@uol.com.br
Aldrighi
Cláudia
C
Ono
Carla
C
Buchpiguel
Carlos
C
Montag
Eduardo
E
Fells
Klaus
K
Arruda
Eduardo
E
Gemperli
Rolf
R
Aldrighi
José Mendes
JM
Ferreira
Marcus Castro
MC
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
D003911:Dextrans; D020034:Silicone Gels; D017556:Technetium Compounds