title: Feasibility of sentinel lymph node biopsy through an inframammary incision for a nipple-sparing mastectomy.
abstract: BACKGROUND
  Nipple-sparing mastectomy (NSM) via an inframammary (IM) incision has been described for selected patients with breast cancer. However, the application of sentinel lymph node (SLN) mapping via an IM incision for NSM has yet to be reported. The objective of this study is to determine the technical feasibility of performing SLN through an IM incision without making an axillary counterincision.
  
  
  METHODS
  We retrospectively reviewed our single-institutional experience with SLN biopsy and NSM through IM incisions between January 2006 and March 2008. Clinicopathologic factors were analyzed regarding indications, technical details, postoperative morbidity, and follow-up.
  
  
  RESULTS
  Fifty-two patients underwent 87 NSM through an IM incision (17 unilateral, 35 bilateral) with immediate reconstruction and SLN biopsy. Indications for surgery included invasive breast cancer (n = 21), ductal carcinoma in situ (DCIS) (n = 18), and prophylactic (n = 48). Mean tumor size of invasive carcinoma was 2.1 cm. The mean mastectomy specimen weight was 437 g. Subareolar injection consisted of blue dye (n = 43), technetium sulfur colloid (n = 2), or combination injection (n = 42). SLN biopsy through an IM incision was successfully performed in 84 of 87 cases (96.6%). A mean of 2.8 SLN were removed with a positive sentinel node encountered in 8 of 21 patients (38%) with invasive cancer. No complications were observed regarding the SLN portion of the operation. With a median follow-up of 6.5 months (range, 0.4-23 months), there have been no axillary local recurrences.
  
  
  CONCLUSIONS
  SLN biopsy can be performed through an IM incision during a NSM, avoiding a secondary axillary incision.
authors.affiliation: Breast Program, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. john.kiluk@moffitt.org
authors.forename: John V
authors.initials: JV
authors.lastname: Kiluk
authors.forename: Alfredo A
authors.initials: AA
authors.lastname: Santillan
authors.forename: Paramjeet
authors.initials: P
authors.lastname: Kaur
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
authors.forename: Tammi
authors.initials: T
authors.lastname: Meade
authors.forename: Dan
authors.initials: D
authors.lastname: Ramos
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cox
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000601:surgery; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009558:Nipples / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue