0
Correspondence and Brief Communications |

Important Technical Considerations for Skin-Sparing Mastectomy With Sentinel Lymph Node Dissection

Henry Mark Kuerer, MD, PhD; Savitri Krishnamurthy, MD; Steven J. Kronowitz, MD
Arch Surg. 2002;137(6):746. doi:.
Text Size: A A A
Published online

Extract

Two of the most important new developments in the surgical treatment of early-stage breast cancer include skin-sparing mastectomy and sentinel lymph node biopsy. Combining these surgical techniques may achieve an optimal aesthetic outcome while minimizing the potentially significant morbidity associated with axillary dissection. Therefore, we congratulate Stradling et al1 on their insightful article that carefully describes the surgical nuances of these combined operative techniques. However, one potentially critical aspect of the combined procedure was not addressed. This concerns the intraoperative identification of axillary lymph node metastases. The false-negative rate for the detection of axillary metastases using frozen section and touch preparation techniques has been reported to be as high as 89%; at our institution it is about 54%.2,3 Therefore, the true status of the sentinel lymph node may be available only after a permanent histologic examination several days following the procedure. Although the current standard of care is to perform a completion axillary lymph node dissection if a sentinel node is found to contain metastases, this can significantly affect immediate autologous breast reconstruction. At our institution and many others, the vessels of the thoracodorsal vascular system are the preferred recipient vessels for free transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction. In this situation, reoperative axillary surgery has the potential to compromise the vascular pedicle of the reconstructed breast. The presence of a plastic surgeon during reoperative axillary surgery may enhance the safety of this operation. Furthermore, the optimal time to remove additional axillary nodes may be after adjuvant therapy, allowing for the establishment of a local blood supply to the TRAM flap. Other options that would eliminate the risk of vascular injury during reoperation include the use of the internal mammary vessels as recipient vessels for a free TRAM flap or the use of a pedicled TRAM flap. New developments in breast cancer treatment necessitate a team approach with increased communication between the breast surgeon, pathologist, and plastic surgeon in planning surgery for these patients. It is also of utmost importance to inform patients of the potential implications of skin-sparing mastectomy with sentinel node biopsy and immediate free TRAM breast reconstruction.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

June 1, 2002
Carlos H. Morales, MD; Maria I. Villegas, MD
Arch Surg. 2002;137(6):746. doi:.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();