Is Sentinel lymph node biopsy (SLNB) required prior to mastectomy and implant-based reconstruction (IBR)?
Association of Breast Surgery ePoster Library. Kittel B. 05/13/19; 257107; P063
Ms. Barbra Kittel
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P063
Topic: Breast surgery
Introduction: In Milton Keynes University Hospital (MKUH) SLNB is performed as a separate procedure prior to breast reconstruction surgery. With reconstruction practices moving away from Latissimus Dorsi flaps towards IBR the risk of pedicle damage if axillary clearance is required is not as significant of an issue. This service improvement project aimed to assess the feasibility of performing SLNB simultaneously with mastectomy and reconstruction to avoid additional surgery and any associated complications.Method:Patients undergoing mastectomy and IBR between July 2017-August 2018 at MKUH were included. Data collected included age, axillary assessment (radiology, FNA or biopsy and/or SNLB) adjuvant therapy and post-operative complications. Results:46 patients were included. 28% (13 out of 46) had positive lymph nodes. Of these, 38% (5/13) were identified prior to mastectomy through ultrasound +/- FNA and the remaining 62% (8/13) were identified through SLNB. 89% (41/46) of patients had SLNB prior to mastectomy. SLNB lead to a change in planned treatment, with patients receiving neoadjuvant chemotherapy prior to mastectomy, in 11% of cases. Conclusions:Just over 1 in 10 patients required a second axillary procedure following SLNB or had their management planned altered based on the results. Changing practice to perform SLNB simultaneously with the mastectomy and IBR is feasible with increasing preference for IBR removing the risk to pedicled flaps. Increased image guided biopsies potentially reduces the positive SLNB rate further. Simultaneous SNLB and breast surgery would remove the risk of two procedures, expedite patient management both directly and indirectly, and reduce admissions.
Topic: Breast surgery
Introduction: In Milton Keynes University Hospital (MKUH) SLNB is performed as a separate procedure prior to breast reconstruction surgery. With reconstruction practices moving away from Latissimus Dorsi flaps towards IBR the risk of pedicle damage if axillary clearance is required is not as significant of an issue. This service improvement project aimed to assess the feasibility of performing SLNB simultaneously with mastectomy and reconstruction to avoid additional surgery and any associated complications.Method:Patients undergoing mastectomy and IBR between July 2017-August 2018 at MKUH were included. Data collected included age, axillary assessment (radiology, FNA or biopsy and/or SNLB) adjuvant therapy and post-operative complications. Results:46 patients were included. 28% (13 out of 46) had positive lymph nodes. Of these, 38% (5/13) were identified prior to mastectomy through ultrasound +/- FNA and the remaining 62% (8/13) were identified through SLNB. 89% (41/46) of patients had SLNB prior to mastectomy. SLNB lead to a change in planned treatment, with patients receiving neoadjuvant chemotherapy prior to mastectomy, in 11% of cases. Conclusions:Just over 1 in 10 patients required a second axillary procedure following SLNB or had their management planned altered based on the results. Changing practice to perform SLNB simultaneously with the mastectomy and IBR is feasible with increasing preference for IBR removing the risk to pedicled flaps. Increased image guided biopsies potentially reduces the positive SLNB rate further. Simultaneous SNLB and breast surgery would remove the risk of two procedures, expedite patient management both directly and indirectly, and reduce admissions.
P063
Topic: Breast surgery
Introduction: In Milton Keynes University Hospital (MKUH) SLNB is performed as a separate procedure prior to breast reconstruction surgery. With reconstruction practices moving away from Latissimus Dorsi flaps towards IBR the risk of pedicle damage if axillary clearance is required is not as significant of an issue. This service improvement project aimed to assess the feasibility of performing SLNB simultaneously with mastectomy and reconstruction to avoid additional surgery and any associated complications.Method:Patients undergoing mastectomy and IBR between July 2017-August 2018 at MKUH were included. Data collected included age, axillary assessment (radiology, FNA or biopsy and/or SNLB) adjuvant therapy and post-operative complications. Results:46 patients were included. 28% (13 out of 46) had positive lymph nodes. Of these, 38% (5/13) were identified prior to mastectomy through ultrasound +/- FNA and the remaining 62% (8/13) were identified through SLNB. 89% (41/46) of patients had SLNB prior to mastectomy. SLNB lead to a change in planned treatment, with patients receiving neoadjuvant chemotherapy prior to mastectomy, in 11% of cases. Conclusions:Just over 1 in 10 patients required a second axillary procedure following SLNB or had their management planned altered based on the results. Changing practice to perform SLNB simultaneously with the mastectomy and IBR is feasible with increasing preference for IBR removing the risk to pedicled flaps. Increased image guided biopsies potentially reduces the positive SLNB rate further. Simultaneous SNLB and breast surgery would remove the risk of two procedures, expedite patient management both directly and indirectly, and reduce admissions.
Topic: Breast surgery
Introduction: In Milton Keynes University Hospital (MKUH) SLNB is performed as a separate procedure prior to breast reconstruction surgery. With reconstruction practices moving away from Latissimus Dorsi flaps towards IBR the risk of pedicle damage if axillary clearance is required is not as significant of an issue. This service improvement project aimed to assess the feasibility of performing SLNB simultaneously with mastectomy and reconstruction to avoid additional surgery and any associated complications.Method:Patients undergoing mastectomy and IBR between July 2017-August 2018 at MKUH were included. Data collected included age, axillary assessment (radiology, FNA or biopsy and/or SNLB) adjuvant therapy and post-operative complications. Results:46 patients were included. 28% (13 out of 46) had positive lymph nodes. Of these, 38% (5/13) were identified prior to mastectomy through ultrasound +/- FNA and the remaining 62% (8/13) were identified through SLNB. 89% (41/46) of patients had SLNB prior to mastectomy. SLNB lead to a change in planned treatment, with patients receiving neoadjuvant chemotherapy prior to mastectomy, in 11% of cases. Conclusions:Just over 1 in 10 patients required a second axillary procedure following SLNB or had their management planned altered based on the results. Changing practice to perform SLNB simultaneously with the mastectomy and IBR is feasible with increasing preference for IBR removing the risk to pedicled flaps. Increased image guided biopsies potentially reduces the positive SLNB rate further. Simultaneous SNLB and breast surgery would remove the risk of two procedures, expedite patient management both directly and indirectly, and reduce admissions.
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