title: [Axillary lymph node dissection after breast reconstruction by pedicled Latissimus dorsi: Operative steps and outcomes].
abstract: OBJECTIVE
  We retrospectively reviewed all the cases of axillary lymph node dissection (ALND) performed within a year after an immediate breast reconstruction procedure by a pedicled Latissimus dorsi, which is transferred to the anterior thoracic wall through an axillary funnel. Operative technical steps are described taking account of the new anatomical relationship of the axilla.
  
  
  METHODS
  We assessed postoperative immediate complications and late sequelaes.
  
  
  RESULTS
  From 1999 to 2013, 21 ALND were performed. Immediate postoperative period was free of complication in 85% of cases when following the operative steps described in this work. Partial or total necrosis of the reconstructed breast did not occur. With a median follow-up of 64 months, 6 patients (28% of the whole population) presented at least one sequelae like a feeling of heavy arm (n=2, 9%) or a lymphedema (n=3, 14%), a chronic neuropathic pain (n=4, 19%) or a limitation in the arm range of motion (n=2, 9%).
  
  
  CONCLUSIONS
  ALND after immediate breast reconstruction by a pedicled Latissimus dorsi is feasible and safe, without any additional postoperative complication in comparison with a classic ALND.
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. Electronic address: docteur.carrabin@gmail.com.
authors: N
authors: N
authors: Carrabin
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors: M-A
authors: MA
authors: Dammacco
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors: F
authors: F
authors: Beurrier
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors: N
authors: N
authors: Chopin
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors: S
authors: S
authors: Klingler
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors: D
authors: D
authors: Ferraioli
authors: Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
authors: C
authors: C
authors: Faure
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Axillary lymph node dissection; Breast reconstruction; Curage axillaire; Pedicled Latissimus dorsi; Reconstruction par lambeau de grand dorsal; Surgical operative steps; Technique chirurgicale