title: Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography.
abstract: BACKGROUND
  The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG).
  
  
  METHODS
  Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p \ 0.05 significant, or p \ 0.017 when Bonferroni correction was applied.
  
  
  RESULTS
  All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG.
  
  
  CONCLUSIONS
  The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.
authors.affiliation: Department of Surgery, Federal University of Paraná, 181, General Carneiro Street, Curitiba, Parana 80060900, Brazil. heitor@cermen.com.br
authors.forename: Heitor Naoki
authors.initials: HN
authors.lastname: Sado
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Graf
authors.forename: Lady W
authors.initials: LW
authors.lastname: Canan
authors.forename: Giovana G
authors.initials: GG
authors.lastname: Romano
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Timi
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Matias
authors.forename: Airton S
authors.initials: AS
authors.lastname: Yamada
authors.forename: Luiz C
authors.initials: LC
authors.lastname: Woellner
authors.forename: Gilvani A Oliveira
authors.initials: GA
authors.lastname: Cruz
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001365:Axilla / Q000000981:diagnostic imaging / Q000601:surgery; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D011877:Radionuclide Imaging; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D018709:Statistics, Nonparametric; D013668:Technetium Tc 99m Aggregated Albumin; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin