Role of Axillary Reverse Mapping in Breast Cancer to Decrease Complications

ABSTRACT

Introduction: The concept of axillary reverse mapping (ARM) is to map this part of upper limb drainage. If lymphedema ofthe upper extremity is caused by removing lymphatics and nodes situated in the axilla, theoretically the ability to map theselymphatics would enable surgeons to preserve them.Aim: The aim of the study was to study the effect of ARM technique on the incidence of seroma and lymphedema after modifiedradical mastectomy (MRM).Materials and Methods: A prospective, randomized, and controlled study over 40 female patients who underwent MRM. Patientswere divided and randomized into study and control groups, 20 patients for each. In the study group, the ARM procedure wasdone by injecting 2.5 ml of methylene blue dye intradermally and subcutaneously in the upper inner ipsilateral arm along themedial intramuscular groove before axillary lymph node dissection. Operative and post-operative results were recorded.Results: ARM procedure and successful visualization of arm lymphatics were achieved in 17 patients (85%). Statistically,there was no significant difference between the two groups regarding patient and tumor characteristics, operative time anda number of excised lymph nodes. There was significant difference favoring the ARM group in decreasing the incidence ofseroma, lymphedema and time passed till remove drains.Conclusion: ARM procedure facilitated arm lymphatics visualization. It is an easy non-time-consuming procedure. It resulted in asignificant reduction in the incidence of seroma and lymphedema, with a considerable reduction in the overall complications rate.