Author: Fernando Serra

Bulletin 173 / Resident's section

Evaluation of the interference of transaxillary breast augmentation on the sentinel lymph node integrity

Purpose Breast augmentation with silicone implants is the first option for mammary hypotrophy. The transaxillary approach has been gained popularity because of the absence of scar on the breast, what leads to a more natural aesthetic result. Breast cancer is the most relevant factor for prognosis and treatment. However, in early stages is controversial the need of an axillary dissection, due to the morbidity of the procedure. Since the mammography was established as a screening test, a consistent number of women are being diagnosed in early stages. In these cases (T1 T2), with a non palpable axillary node, axillary dissection is no longer the recommended procedure for screening the lymphatic chain. The sentinel lymph node biopsy is a minimum invasive and high accurate method for axillary staging, with high sensibility (84-98%) and low false negative (2-8.8%),becoming the standard technique, and its practice has reduced the morbidity of early breast cancer treatment. However this non invasive method is not indicated for patients who have been submitted to axillary surgery, due to the controversy about the interference of the axillary approach on the evaluation of the axillary drainage. The goal of this study is to evaluate the behavior of the axillary lymphatic drainage on patients submitted to transaxillary breast augmentation. Methods Twenty seven patients were selected based on inclusion exclusion criteria age, grade of ptose, absence of mammary pathology, absence of any disease or pregnancy to be submited to breast augmentation by the transaxilary approach. To analyze the lymphatic integrity all patients were submitted to mammary lymphoscintography with technetium -sestamibi before the surgical procedure, twenty one days and six months after the procedure. The axillary lymphatic chain and the first axillary lymph node were analyzed and compared to the preoperative images. Results in all patients the images of the lymphatic drainage has not been altered after the procedure, and the sentinel lymph node could be identified. Conclusion the preservation of the lymphatic drainage and the detection of the sentinel lymph node after transaxillary breast augmentation prove the evidence that the procedure does not alters the mammary drainage integrity. This translates to the possibility of a less invasive treatment in patients with early breast cancer and prior breast augmentation by the transaxillary approach.

Monografia vencedora do 3o lugar do prêmio Francisco Slagado, destinado a monografias apresentdas por residentes R1 e R2 ao concurso de monografias da Instituto Ivo Pitanguy.

Read more