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Incisional approach for lymph node dissection and mastectomy with implant based reconstruction, does it matter?
Rachel Aliotta MD & Risal Djohan MD
The Cleveland Clinic
2016-02-14
Presenter: Rachel Aliotta MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Recent studies have suggested a relationship between axillary lymph node dissection (ALND) performed during time of mastectomy and tissue expander (TE) reconstruction and risk of implant failure (ie. loss) when compared to those undergoing only sentinel lymph node biopsy (SLNB) in patients undergoing breast cancer surgery and implant-based reconstruction. The authors were able to exclude radiation and increased infection burden as confounding variables to explain these observed losses, however they were unable to evaluate the influence of the incisions placed and specific pathway of dissection utilized during their surgical approach, and the effect these may have on their outcomes. The purpose of this study is to evaluate the difference in outcome of patients undergoing mastectomy with ALND through a single mastectomy incision versus separate incisions. Methods: Retrospective review performed on patients undergoing simple mastectomy, sentinel node biopsy and/or axillary node dissection and placement of tissue expanders (n = 1350) during the same operative encounter performed by the breast surgery team oncologic and reconstructive teams from 2010-2015 with at least 3 months follow up. Patient cohorts were divided as: patients receiving simple mastectomy/SLNB/TE, and those patients receiving mastectomy/SLNB+/-ALND/TE reconstruction. Perioperative and long-term reconstructive surgical outcomes were evaluated to 6 months following their primary surgical procedure. Conclusion: As we move forward in an era of personalized breast cancer treatment it is our job as plastic surgeons to work with our breast surgery colleagues collaboratively to determine the effect of all aspects of our surgical approaches to achieve optimal surgical and reconstructive outcomes.
