title: Sentinel lymph node biopsy before mastectomy and immediate breast reconstruction does not significantly delay surgery in early breast cancer.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) before mastectomy and immediate breast reconstruction (IBR) may help to avoid the negative cosmetic effects of radiotherapy on reconstructed breasts in lymph node-positive patients. Concerns have been raised regarding possible delays whilst awaiting the SLNB result prior to definitive surgery, which needs to be performed within 31 days of cancer diagnosis. The aim was to investigate whether initial SLNB delays mastectomy and IBR.
  
  
  METHODS
  All patients who had IBR between January 2005 and 2007 were reviewed retrospectively. Before October 2005 axillary staging was performed simultaneously with mastectomy and IBR (Group I). After October 2005, SLNB was performed as an initial procedure and patients with positive SLNB were only offered a temporary tissue expander to be replaced by autogenous reconstruction after completing the cancer treatment (Group II). Date of diagnosis and waiting times were recorded and the two groups were compared. Different reasons for delays in treatment were studied.
  
  
  RESULTS
  One hundred and thirty-nine IBR (123 patients) were included in the statistical analysis (67 IBR in Group I and 72 IBR in Group II). Seventy-one patients (57.7%) had no delay (mean waiting time of 23 days). Fifty-two patients (42.3%) had delay longer than 31 days (mean waiting time of 66 days). Group I patients had a mean waiting time (standard deviation) of 38.8 (38) days and Group II patients 42.7 (24) days (p = 0.51).
  
  
  CONCLUSIONS
  In this group of patients, SLNB before mastectomy and IBR does not significantly delay definitive breast cancer surgery.
authors.affiliation: Breast Surgery Unit, Norfolk and Norwich University Hospital, Norwich, UK.|General Surgery, Oxford University Hospitals, Oxford, UK.
authors.forename: Gurdeep S
authors.initials: GS
authors.lastname: Mannu
authors.affiliation: Breast Surgery Unit, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Navi
authors.affiliation: Breast Surgery Unit, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Maged
authors.initials: M
authors.lastname: Hussien
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013997:Time Factors
keywords: breast oncology; immediate breast reconstruction; mastectomy; sentinel lymph node biopsy