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J Reconstr Microsurg 2022; 38(09): 721-726
DOI: 10.1055/s-0042-1744503
Original Article

Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: A Prospective Study

Benjamin D. Schultz
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Darren Sultan
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Grace Ha
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Alexander Gibstein
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Khang Nguyen
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Sarah L. Barnett 
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Rebecca C. Suydam
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Armen K. Kasabian
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Mark L. Smith
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
,
Neil Tanna
1   Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Great Neck, New York
› Author Affiliations Funding None.
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Abstract

Background Accurate assessment of regional lymph node basins is critical for oncological management of breast cancer. The internal mammary lymph node (IMLN) basin directly drains the medial pole of the breast, but biopsy is not commonly performed. While the axillary sentinel lymph node sample remains the standard of care, the majority of patients who have been found to have a positive IMLN biopsy have simultaneously had negative axillary sentinel lymph nodes. This study prospectively examines routine IMLN biopsy during microsurgical breast reconstruction.

Methods An IRB-approved study of routine IMLN biopsies in 270 consecutive patients who underwent microsurgical breast reconstruction was performed from July 1, 2018, to June 1, 2021. Recorded data included unilateral or bilateral breast reconstruction, unilateral or bilateral IMLN sampling, patient demographics, disease stage, and pathologic findings of IMLN.

Results The majority of patients, 240 of 270 patients (88.9%), had bilateral reconstruction. Overall, 5 out of 270 (1.9%) patients had positive IMLN; one of these patients had positive axillary sentinel lymph nodes. The IMLN biopsy results in two of the five patients affected the clinical course as they were upstaged and required chemoradiation.

Conclusion Direct visualization of the internal mammary lymph nodes during dissection of the recipient vessels for microsurgical breast reconstruction allows for convenient sampling, with minimal donor site morbidity and enhances the therapeutic management of patients in whom nodal involvement is present. As such, the authors recommend IMLN sampling.

Keywords

breast reconstruction - internal mammary lymph node - mastectomy - DIEP flap - microsurgery - flap

Note

This research was approved by the Hofstra/Northwell IRB department, IRB #: 18–0584




Publication History

Received: 15 October 2021

Accepted: 20 February 2022

Article published online:
15 March 2022

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