Rio de Janeiro State University, Brazil.
Aesthet Surg J. 2011 May;31(4):392-400. doi: 10.1177/1090820X11404399.
The transaxillary approach for breast augmentation has gained popularity because of the absence of scarring on the breast. However, the effects of this procedure on breast cancer detection and treatment (which rely heavily on the results of axillary status studies) remain under debate. Specifically, sentinel lymph node biopsy is not indicated for patients who have undergone axillary surgery, due to controversy about the interference of the axillary approach with evaluation of the axillary drainage.
The authors evaluate changes in axillary lymphatic drainage in patients who underwent transaxillary breast augmentation.
Twenty-seven patients who presented to Rio de Janeiro State University for breast augmentation were selected for this study. All patients underwent preoperative mammary lymphoscintigraphy, a subsequent transaxillary breast augmentation, and postoperative lymphoscintigraphy at 21 days and six months after the procedure. The postoperative imaging results examining the axillary lymphatic chain and the first axillary lymph node were analyzed and compared to the preoperative images.
One of the 27 patients (4.5%) demonstrated a lower rate of lymphatic drainage at 21 days postoperatively compared to preoperative values, but the flow rate had recovered by her six-month follow-up visit. All other patients showed no changes between the preoperative and postoperative images at either time point. The sentinel lymph node remained visible in all patients at all time points, and all breasts showed drainage primarily to the axillary lymphatic chain. Two patients experienced hematoma and one patient experienced late infection at four months postoperatively. The sentinel lymph node was still evident in both axillae.
The data showed preservation of lymphatic drainage and visible sentinel lymph nodes even after transaxillary breast augmentation. Therefore, the authors believe that this procedure does not alter the integrity of mammary drainage for properly selected patients. These data provide surgeons with a less invasive treatment option for patients with early breast cancer, even when they have undergone prior breast augmentation through a transaxillary approach.
经腋窝入路隆乳术因乳房无瘢痕而受到青睐。然而，该手术对乳腺癌检测和治疗的影响（严重依赖腋窝状态研究结果）仍存在争议。具体来说，由于腋窝入路会干扰腋窝引流的评估，因此对于已接受腋窝手术的患者，不建议进行前哨淋巴结活检。
作者评估经腋窝入路隆乳术后腋窝淋巴引流的变化。
本研究选择了 27 名因隆乳术就诊于里约热内卢州立大学的患者。所有患者均接受术前乳腺淋巴闪烁显像、随后的经腋窝隆乳术以及术后 21 天和 6 个月的淋巴闪烁显像。对术后检查腋窝淋巴链和第一腋窝淋巴结的影像学结果进行分析，并与术前图像进行比较。
27 例患者中有 1 例（4.5%）在术后 21 天的淋巴引流率较术前值降低，但在 6 个月的随访时已恢复。所有其他患者在两个时间点的术前和术后图像均未显示变化。在所有时间点，所有患者的前哨淋巴结均可见，所有乳房的引流均主要流向腋窝淋巴链。2 例患者术后 4 个月出现血肿，1 例患者出现迟发性感染。在两个腋窝中仍可见到前哨淋巴结。
即使在经腋窝隆乳术后，数据也显示保留了淋巴引流和可见的前哨淋巴结。因此，作者认为，对于选择适当的患者，该手术不会改变乳腺引流的完整性。这些数据为外科医生提供了一种对早期乳腺癌患者的侵袭性更小的治疗选择，即使他们已经通过经腋窝入路接受了先前的乳房隆乳术。
