Oncoplastic Surgery and Outcome prediction deserve Axillary Lymph Node Dissection – Treatment results of 51 cases of breast cancer.

Abstract

Background: The current trend of early breast cancer (BC) management is to conserve axillary lymph nodes (ALNs) with the idea that ALN dissection (ALND) has no therapeutic value. Owing to wide individual variations of number of ALNs, lymph node ratio (LNR) could predict recurrence and death (‘Incident’) better and ALND is in need for LNR expression. ALND invite lymphedema thus oncoplastic surgery (OPS) along with ipsilateral ALND might cause enlargement of reconstructed breast resulting in spontaneous symmetrization. The aim of this study was to determine role of LNR for prediction of ‘Incident’ of BC and spontaneous symmetrization of breasts of OPS as a new concept through utilization of ALND. The objectives of study of ALND were to assess LNR categories to predict ‘Incident’ of BC patients, and outcome of ipsilateral ALND for spontaneous breast symmetrization of OPS.

Methods: This prospective study was conducted on 51 consecutive BC patients treated and under follow-up study. Patients’ information was collected using research instrument after obtaining informed consent of patients and approval of Institutional Ethical Board.

Results: The median age, weight of patients and number of LNs were 48 years, 59 kg and 12 LNs respectively. Postmenopausal and ALND negative were 67% and 26% respectively. Follow-up study indicated 12% patients had ‘Incident’. The difference of ‘Incident’ and LNR categories was significant (p <0^.001). Spontaneous enlargements of all OPS breasts were observed.

Conclusions: High-risk LNR has strong association with recurrences and deaths.  Ipsilateral axillary lymph node dissection with oncoplastic surgery lead to lymphedema of the operated cancer bearing breast and should be a routine procedure to have enlargement of operated-breast to achieve ‘spontaneous breasts symmetrization’ instead of current practice of ‘iatrogenic breasts symmetrization’. This discovery will be well accepted by patients desiring oncoplastic surgery of cancer bearing breasts but unwilling reduction mammoplasty of contralateral normal breasts.

Key words: Oncoplastic surgery axillary lymph node dissection; breast cancer surgery spontaneous operated breast enlargement; axillary lymph node ratio breast cancer outcome prediction.