Immediate Microsurgical Breast Reconstruction and Simultaneous Sentinel Lymph Node Dissection: Issues with Node Positivity and Recipient Vessel Selection

Michael S Curtis; Brian Arslanian; Salih Colakoglu; Adam M Tobias; Bernard T Lee

doi:10.1055/s-0031-1281513

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2011; 27(7): 445-448
DOI: 10.1055/s-0031-1281513

Immediate Microsurgical Breast Reconstruction and Simultaneous Sentinel Lymph Node Dissection: Issues with Node Positivity and Recipient Vessel Selection

Michael S. Curtis¹ , Brian Arslanian² , Salih Colakoglu² , Adam M. Tobias² , Bernard T. Lee²

¹Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York
²Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Abstract

ABSTRACT

Sentinel lymph node dissection (SLND) during mastectomy has been increasing given the decreased risk of lymphedema. Simultaneous reconstruction with a microsurgical breast reconstruction is often performed, but with node positivity a completion axillary lymph node dissection (ALND) must be performed subsequently. This study examines the potential risks especially in relation to microsurgical reconstruction. All patients undergoing microsurgical breast reconstruction at an academic institution from 2004 to 2010 were evaluated in a prospective database. Patients with immediate reconstruction and SLND were identified. Management of positive lymph node status was ascertained through extensive chart review. There were 610 reconstructions performed, 170 delayed and 440 immediate. From the immediate reconstructions, 110 patients (25%) had SLND and of these patients, 16 (14.55%) had a positive SLND. All 16 patients had internal mammary recipient vessels for free tissue transfer. Seven patients had intraoperative completion ALND, while nine patients had staged completion ALND at a later date. There were no adverse affects from completion ALND. Simultaneous mastectomy, SLND, and microsurgical reconstruction can be performed safely. The internal mammary vessels are preferred recipient vessels as node positive patients may require subsequent completion ALND. If a thoracodorsal anastomosis is performed, a potential risk exists for vessel injury and flap loss with completion ALND.

KEYWORDS

Breast reconstruction - sentinel lymph node biopsy - deep inferior epigastric perforator flap - microsurgical breast reconstruction - breast cancer

Full Text

References

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Bernard T LeeM.D. F.A.C.S.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center

Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA 02215

Email: blee3@bidmc.harvard.edu