Management of chylous leakage after breast surgery: Report of four cases

Abstract

Chylous leakage is a rare occurrence after breast surgery. Trauma to the thoracic duct and its main distribution may be the main cause of chylous leakage, but the cause of such an injury during breast surgery is unknown. We herein report the first case of chylous leakage from many minimal lymph ducts in a skin flap. In all, four cases of chylous leakage were observed out of 1 096 breast cancer patients who underwent axillary lymph node dissection. Of these four cases, three cases were successfully treated conservatively; however, surgical exploration was performed in the fourth case because of the large drainage volume. Furthermore, we reviewed the recently published studies on chylous leakage after breast surgery; 20 cases (our 4 cases included) have been reported in all. Of the 20 pooled cases, most were cured with conservative treatment and only three cases were cured with surgical treatment.

High‐output chyle leak after breast‐conserving surgery and sentinel lymph node biopsy

“…Chylous leak or fistula following surgical procedures of the breast is rare. Nearly all reports occur after axillary lymph node dissection with a reported incidence of <0.5% …”

“…Nearly all reports occur after axillary lymph node dissection with a reported incidence of <0.5%. 7,8 To our knowledge, this is the first and only reported case of chyle leak after breast-conserving surgery with sentinel node biopsy. Chyle leak following mastectomy and sentinel node biopsy has been described on two occasions: The first case involving a chyle leak after nipple-sparing mastectomy, sentinel node biopsy, and tissue expander placement.…”

Chylous leakage after axillary lymph node dissection in a patient with breast cancer

“…Chylous leakage after axillary dissection in breast cancer patients is a very rare complication because the thoracic duct usually has no direct anatomical relation to the axilla . To date, only 31 cases, including our case, have been reported in the literature . Because of its rarity, the appropriate management for chylous leakage of the axilla is controversial.…”

“…The higher incidence on the left side may result from anatomical reasons: the thoracic duct begins in the abdomen in the left side, crosses the midline to the left side at the level of the aortic arch and continues ascending until it reaches the root of the neck where it joins the venous system . With regard to treatment, 25 (80.6%) patients recovered with conservative treatment and 6 (19.4%) patients received surgery . Conservative treatments such as drainage, diet control, and compression is believed to have been applied in most patients as an initial treatment .…”

Chyle leak after axillary lymph node dissection

“…occurred following left sided level II or III axillary node clearance. 2 While an algorithm for management in such cases is far from established in the literature, a conservative approach by drain output monitoring until the chyle leak subsides spontaneously is usually recommended, 3 and surgical exploration and treatment should only be performed if drainage output remains high and continuous (persistent leakage more than 2 weeks, or more than 1 L drainage for more than 1 week). 5 Our case highlights the benefit of a conservative approach.…”