Abstract PS2-03-26: Lymphatic-sparing sentinel lymph node biopsy to prevent breast cancer-related lymphedema

Abstract Background: Breast cancer-related lymphedema (BCRL) remains a persistent and impactful morbidity associated with axillary surgery. Even with sentinel lymph node biopsy (SLNB), the reported incidence of BCRL is 5-7%. As surgical oncology shifts toward minimizing treatment-related morbidity—particularly in patients with clinically node-negative, early-stage breast cancer—techniques that reduce the risk of BCRL are increasingly valuable. Large trials such as SOUND and INSEMA support de-escalation of axillary surgery, demonstrating that SLNB may be safely omitted in select low-risk patients. These findings reinforce efforts to refine surgical techniques for those who still require axillary staging. Technique: We propose a novel, broadly applicable surgical approach: lymphatic-sparing sentinel lymph node biopsy (LSSNBX). This technique preserves and reapproximates the afferent and efferent lymphatic channels after sentinel node excision to facilitate lymphangiogenesis and reduce postoperative lymphedema risk. Unlike axillary reverse mapping (ARM)-dependent approaches, LSSNBX avoids additional mapping procedures, making it more feasible in varied practice settings. The procedure begins with dual-agent mapping (Technetium-99m, indocyanine green [ICG], or blue dye). After identification of the sentinel lymph node, an axillary crease incision is used to access the node. During excision, the afferent and efferent lymphatic bundles are carefully preserved and prevented from retracting. These lymphatic channels are then reapproximated using an absorbable suture, promoting potential reconnection and continuity of lymphatic flow. Importantly, this method simplifies prior ARM-based strategies by performing lymphatic preservation routinely, regardless of ARM findings. Results: A retrospective review at our institution included 103 patients: 52 underwent LSSNBX and 51 underwent standard SLNB without lymphatic preservation. Patient demographics indicated the LSSNBX group was older and had a lower mean BMI. At three-month follow-up using bioimpedance spectroscopy (SOZO®), no cases of BCRL were identified in either group. Notably, the LSSNBX technique added minimal operative time and required no specialized equipment, supporting its feasibility and cost-effectiveness. Conclusion: LSSNBX is a safe, simple, and scalable modification of standard SLNB that aligns with the current movement toward minimally invasive, morbidity-reducing surgical oncology. By preserving and reapproximating lymphatic channels intraoperatively, this technique may reduce the incidence of BCRL and improve long-term patient quality of life. As axillary surgery continues to evolve, the LSSNBX technique represents a promising step in optimizing outcomes. Further studies with larger cohorts and extended follow-up are warranted to validate these preliminary findings. Citation Format: E. Kohilakis, S. Chow, N. Habboosh, M. Bajwa, M. McEvoy, S. Feldman. Lymphatic-sparing sentinel lymph node biopsy to prevent breast cancer-related lymphedema [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-03-26.