Axillary reverse mapping in breast cancer: An overview

Abstract

Standard operative management for breast carcinoma has significantly shifted from extensive procedures to minor interventions. Although axillary dissection was a fundamental component of operative management, sentinel biopsy is an actual process for axillary staging. Axillary dissection may be postponed for cases that have negative SLNs or 1 or 2 infiltrated lymph nodes undergoing breast or axillary radiation. Contrarily, axillary dissection is still the conventional management for patients with clinically positive nodes. Arm lymphedema is a frequent and overwhelming complication of axillary dissection, with a worse impact on the patient’s life. Axillary reverse mapping was recently introduced to map and conserve the lymph drain of the upper limb throughout axillary dissection or sentinel biopsy. A technique based on the theory that the breast’s lymphatic drainage differs from those that drain the arm, so preserving lymphatic drainage of the upper limb can prevent lymphedema, thereby not raising the risk of axillary recurrence. Therefore, this technique is the reverse of sentinel biopsy, which remove the lymph nodes that drain the breast.