title: Relationship between the lymphatic drainage of the breast and the upper extremity: a postmortem study.
abstract: BACKGROUND
  This anatomic study details the lymphatic drainage of the upper extremity (UE) and breast, as well as its course in the axilla and its relation to axillary reverse mapping. Two aspects important for breast cancer surgery were followed: connection between the lymphatics of the UE and breast, and the possible cause of lymphedema of the UE after sentinel node (SN) biopsy.
  
  
  METHODS
  Patent blue dye was injected bilaterally in 23 cadavers with no history of breast carcinoma to simultaneously visualize the lymphatics of the UE and breast. After visualization and dissection of the lymphatic vessels and nodes, a record of their routes was made. A scheme of superficial UE and breast lymphatics was constructed.
  
  
  RESULTS
  After application of color contrast to the UE, 2-4 main afferent collectors were shown. As opposed to cranial and medial collectors, caudal collectors diverged from the axillary vein and entered the caudal axilla. In five (10.8%) cases, the caudal collector entered a node, which was considered to be the SN of the breast. In six (13%) cases, the SN of the breast and SNs of the UE were found in close proximity (up to 1.5 cm).
  
  
  CONCLUSIONS
  Lymphatic drainage of the UE and breast are closely related in the caudal part of the axilla. SN groups for the UE and breast share connections in 24% of cases, which could explain lymphedema after surgery if damaged. Additional studies are needed to further improve our understanding of the lymphatic drainage of the UE and breast.
authors.affiliation: Oncogynecologic Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic. daxpa@seznam.cz
authors.forename: David
authors.initials: D
authors.lastname: Pavlista
authors.forename: Oldrich
authors.initials: O
authors.lastname: Eliska
mesh_terms: D001365:Axilla; D001940:Breast / Q000033:anatomy & histology*; D002102:Cadaver; D004396:Coloring Agents; D004210:Dissection; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology*; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D012394:Rosaniline Dyes; D034941:Upper Extremity / Q000033:anatomy & histology*
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue