The influence of mammaplasty in axillary lymphatic drainage patterns and sentinel lymph node detection.

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609 Background: Controlateral mammaplasty is often necessary during the procedure of breast reconstruction after mastectomy. However the impact of these surgery on axillary lymphatic drainage and sentinel node (SN) detection remains controversial. The American Society of Clinical Oncology (ASCO) published a guideline in 2005 that recommended that SN biopsy should not be performed in patients with previous mammaplasty or axillary surgery. However, because of insufficient evidence and lack of scientific studies, mammaplasty cannot be considered an absolute contraindication for SN biopsy procedure, therefore, the same panelists of the ASCO guideline suggested that a preliminary LSG examination could be done when considering a SN biopsy in patients with previous mammapasty, with the objective of verifying the integrity of the mammary and axillary lymphatics areas. The aim of our study was to evaluate the lymphatic patterns and SN detection rates after mammaplasty by using lymphoSPECT-CT (LS). Methods: Twenty patients who underwent mammaplasty were evaluated by LSG immediately after periareolar injections of Tc 99m labelled sulphur colloid (NanoCIS*) at too time points: before mammaplasty (pre-LS) and between 40 to 60 days after mammaplasty (post-LS). Results: All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between pre-LSG and post-LSG. The average number of hot SN was 1.28 in pre-LS, 1.14 in post-LS. The localisation of hot SN was evaluated by: (1) antero-posterior distance was estimated in centimeter from SN region to dorsal vertebrae spine center; and (2) SN's coronal position was compared to grill rib. The preservation of axillary lymphatic drainage after mammaplasty was allowed for SN detection in all studied breasts and the localisation of the sentinel node was the same after surgery than before. Conclusions: After evaluating the impact of the previous mammaplasty surgery on the accuracy of SLN biopsy, we observed that this surgery does not significantly affect the accuracy of lymphatic mapping and that it will be possible to propose sentinel node biopsy after mammaplasty. No significant financial relationships to disclose.

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