title: Sentinel lymph node biopsy before mastectomy and immediate breast reconstruction may predict post-mastectomy radiotherapy, reduce delayed complications and improve the choice of reconstruction.
abstract: BACKGROUND
  Adjuvant post-mastectomy radiotherapy (RT), which is often unpredicted, is known to increase complications following immediate breast reconstruction (IBR).
  
  
  OBJECTIVE
  To investigate the role of sentinel lymph node biopsy (SLN) in predicting RT and improving the choice of IBR.
  
  
  METHODS
  All patients who had mastectomy and IBR between January 2004 and January 2007 were reviewed retrospectively. Axillary staging (clearance or SLN) was performed at the same time until October 2005 (Group 1), when the Unit's protocol was updated to perform SLN initially prior to mastectomy and IBR (Group 2). Patients in Group 2 with positive SLN were offered either a delayed reconstruction or a temporary subpectoral immediate tissue expander, while all options were offered if SLN was negative and in Group 1 patients.
  
  
  RESULTS
  One hundred and thirty-nine patients were reviewed. 20 patients received unexpected RT in Group 1 (14 tissue expander, 4 Latissimus Dorsi flap with an implant and 2 DIEP flaps) compared to 11 patients in Group 2 who had a temporary tissue expander due to expected RT (P=0.03). Unexpected RT caused delayed complications in 14 patients (70%) compared to no delayed complications in patients who received expected RT in Group 2.
  
  
  CONCLUSIONS
  SLN biopsy before IBR helps to predict RT and avoids its complications on breast reconstruction. Patients with positive SLN biopsy are best offered a temporary subpectoral tissue expander for IBR.
authors.affiliation: Breast Surgery Unit, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom. gurdeepmannu@gmail.com
authors.forename: G S
authors.initials: GS
authors.lastname: Mannu
authors.forename: A
authors.initials: A
authors.lastname: Navi
authors.forename: A
authors.initials: A
authors.lastname: Morgan
authors.forename: S M
authors.initials: SM
authors.lastname: Mirza
authors.forename: S K
authors.initials: SK
authors.lastname: Down
authors.forename: N
authors.initials: N
authors.lastname: Farooq
authors.forename: A
authors.initials: A
authors.lastname: Burger
authors.forename: M I
authors.initials: MI
authors.lastname: Hussien
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods*; D015625:Tissue Expansion Devices