Outcomes of Immediate Breast Reconstruction in Patients Undergoing Single-Stage Sentinel Lymph Node Biopsy and Mastectomy

Abstract

The ability to more definitively plan breast reconstruction after obtaining final histologic analysis of the sentinel lymph node biopsy (SLNB) has led several groups to advocate a staged approach to SLNB and mastectomy. Certain disadvantages are inherent in that approach, including increased patient morbidity, financial expense, and inconvenience. A retrospective review was conducted 195 procedures in which mastectomy and SLNB were performed in a single stage with immediate breast reconstruction (IBR) over a 10-year period. Long-term outcomes were analyzed within the context of patient characteristics and SLNB results. Intraoperative SLNB analysis was found to be a reliable method for planning IBR, as there were no patients noted to have untoward sequelae as a result of a false-negative SLNB, and the probability of postmastectomy radiation therapy was predictable based on the intraoperative SLNB results. We advocate that SLNB be performed in a single stage with mastectomy and IBR.

Is Intraoperative Imprint Cytology Evaluation Still Feasible for the Evaluation of Sentinel Lymph Nodes for Lobular Carcinoma of the Breast?

“…However, we have found it particularly useful when immediate breast reconstruction with mastectomy is planned. 36 It remains to be seen if this decrease in volume of IIC will result in a decrement in the accuracy of SLN analysis.…”

Current Trends in Breast Reconstruction

“…14,15 On the other hand, there are reports advocating that SLNB at the time of definitive surgery had minimal impact on the intraoperative reconstructive plan with a reduced risk of patient morbidity and financial impact. 16,17 Our survey results demonstrated that only 7.7% of plastic surgeons most frequently preferred delayed-immediate BR. This approach entails use of a TE during PMRT until definitive reconstruction can be employed.…”

Pre-mastectomy Sentinel Lymph Node Biopsy: A Strategy to Enhance Outcomes in Immediate Breast Reconstruction

“…Similar to other diagnostic modalities, PM‐SLNB is subject to limitations that require discussion. Opponents of a staged SLNB contend that it may be associated with an increased risk of morbidity because patients must undergo an additional procedure prior to mastectomy . In our experience, 94 PM‐SLNB procedures resulted in only two complications, both of which were minor.…”