Staged sentinel lymph node biopsy before mastectomy facilitates surgical planning for breast cancer patients

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

“…Similarly, Klauber-DeMore et al reported only 3 of 9 (30%) women with a positive SLNB underwent PMRT. 2 Overall, in that study, there were 3 of 9 patients with a positive SLNB as a separate outpatient procedure prior to mastectomy that did not have reconstruction, 2 of whom went on to not require radiation therapy. 2 Obtaining the SLNB results ahead of time may provide some information regarding the potential need of that patient for PMRT, but is not definitive evidence that IBR should not be carried out.…”

“…[1][2][3][4] The advantages posited by the groups supporting that approach are related to the avoidance of complications secondary to postmastectomy radiation therapy (PMRT) or completion axillary lymph node dissection (ALND). Specifically, they cite that obtaining final pathologic review of the SLNB prior to definitive reconstruction would prevent circumstances in which a newly reconstructed breast may be irradiated or potentially interfere with delivery of radiation therapy.…”

MOC-PSSM CME Article: Breast Reconstruction

“…15,16 In some centers, staged sentinel lymph node biopsy has come to play an important role in selecting these patients prospectively. 17 Surgeons may choose to use a temporary tissue expander until staging has been completed and then proceed with definitive reconstruction. 18 Using this approach, patients get the benefit of a trial prosthetic reconstruction and therefore have a better understanding of implant(s) as a treatment option.…”

Advances and surgical decision‐making for breast reconstruction

“…1 Although the risk to an immediate breast reconstruction could be avoided simply by performing an initial complete Level I and II axillary dissection, because all lymph nodes will be removed without the worry about coming back for more axillary surgery, this practice may impose significant surgical morbidity (lymphedema and shoulder dystocia) in patients whose axillary lymph nodes may turn out to be negative for disease on permanent pathologic analysis. 9 Delayed breast reconstruction also may be an option; however, immediate breast reconstruction has well recognized benefits in terms of aesthetics and lessening the psychological effects of mastectomy. 26 Although postoperative axillary radiation may be a consideration for locoregional control when the sentinel lymph node is identified as positive on permanent histopathologic analysis, it does not provide the important prognostic information obtained from the additional lymph node tissue.…”

“…If PMRT is required, then delayed reconstruction is usually the best course; however, if PMRT is not required, then immediate reconstruction is appropriate and permits better aesthetic outcomes. However, because lymph node metastases may not be detected until mastectomy 5 and because micrometastases may not be detected until the final pathology review, [6][7][8][9] it is often not known until several days after mastectomy whether PMRT will be required. If breast reconstruction is performed at the time of mastectomy and it is determined postoperatively that the patient has lymph node involvement, then PMRT may affect the aesthetic outcome adversely, 1,[10][11][12] and the reconstructed breast may cause technical difficulties with radiation delivery to the internal mammary lymph nodes, resulting in either increased lung dose or inadequate radiation doses to these lymph nodes.…”