Routine Sampling of Internal Mammary Lymph Nodes during Microsurgical Breast Reconstruction – Experience Based on 524 Microsurgical Breast Reconstructions

ABSTRACT

Purpose

       Exploration of the internal mammary vessels during microsurgical reconstruction presents an ideal opportunity for identifying and sampling the internal mammary lymph node (IMLN) basin.

Methods

    A retrospective review of patients undergoing microsurgical breast reconstruction using the internal mammary vessels as recipient vessels was conducted from March 2000 to December 2014. Patient demographics, tumor characteristics, preoperative lymph node mapping, reconstructive timing and outcomes were studied. 

Results

        A total of 524 microsurgical breast reconstructions in 516 patients were performed using the internal mammary vessels. IMLNs were sampled in 53 immediate and 42 delayed breast reconstructions. Eight (seven in the immediate and one in the delayed group) of the sampled nodes were positive for cancer metastasis, for an incidence of 8.4% in identified lymph nodes. All patients with metastatic IMLNs subsequently received local-regional radiation and chemotherapy. All patients were alive, and 6 were disease-free at the conclusion of the study period, which had an average follow up of 67.3 months.

Conclusion

       Visible IMLNs should be routinely sampled during recipient vessel preparation for microsurgical breast reconstruction. This series underscores the essential role of plastic surgeons in assisting with disease staging to provide adequate adjuvant treatment and improve the survival of breast cancer patients.