Synchronous Sentinel Node Biopsy in Autologous Breast Reconstruction in Node Negative Axilla

Abstract

Background: National Institute of Clinical Excellence guidelines recommends that all eligible patients with breast cancer who needs mastectomy should be offered immediate breast reconstruction. In Implant based reconstruction sentinel node biopsy (SLNB) is performed at the time of mastectomy in clinically node negative axilla but in autologous free flap reconstruction SLNB is routinely performed upfront. This helps to determine the sentinel node biopsy status prior to autologous reconstruction and allows the surgeons to perform axillary node clearance safely without any threat to the anastomosis when free flaps are anastomosed to thoracodorsal (TD) vessels in axilla. With a trend towards de escalation of axillary surgery in appropriate cases and the increasing use of Internal mammary Vessels (IMV) for vascular anastomosis we proposed that the impact of performing sentinel node biopsy synchronously with mastectomy and immediate DIEP reconstruction will be minimal.