Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography.
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.
Sado
Heitor Naoki
HN
Department of Surgery, Federal University of Paraná, 181, General Carneiro Street, Curitiba, Parana 80060900, Brazil. heitor@cermen.com.br
Graf
Ruth M
RM
Canan
Lady W
LW
Romano
Giovana G
GG
Timi
Jorge R
JR
Matias
Jorge E
JE
Yamada
Airton S
AS
Woellner
Luiz C
LC
Cruz
Gilvani A Oliveira
GA
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
D013668:Technetium Tc 99m Aggregated Albumin