Journal of Breast Cancer C A S E R E P O R T J Breast Cancer 2012 March; 15(1): 133-134 http://dx.doi.org/10.4048/jbc.2012.15.1.133 Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management Jong Min Baek, Jin A Lee, Yu Hee Nam, Gi Young Sung, Do Sang Lee, Jong Man Won Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with inva- sive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemother- apy. The postoperative serosanguinous drainage fluid became “milky” on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alterna- tive in cases where leakage persists or where the output is high. Key Words: Breast neoplasms, Chyle, Lymph node excision, Surgical procedures INTRODUCTION Chylous leakage can result from damage to the thoracic duct or its branches after surgical procedures of various types, such as neck or thoracic surgery [1]. However, it is an unusual occur- rence after axillary surgery. Although the majority of chylous leakage cases after breast surgery are managed conservatively, we chose to do a re-operation because of the presence of a high chyle output. Herein, we reported our experience of a case of chylous leakage after axillary lymph node dissection, that was treated surgically. CASE REPORT A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy. Four cycles of neoadjuvant adriamycin-docetaxel chemotherapy had been administered before the surgery. The surgical proce- dure was uneventful and two suction drains were left at the mastectomy site and axilla, in a routine manner. Postoperatively, the drained fluid was serosanguinous in nature. However, it Correspondence: Do Sang Lee Department of Surgery, Bucheon St. Mary Hospital, The Catholic University of Korea College of Medicine, 327 Sosa-ro 327 beon-gil, Wonmi-gu, Bucheon 420-717, Korea Tel: +82-32-340-7023, Fax: +82-32-340-2036 E-mail: dosangs@catholic.ac.kr Received: August 12, 2011 Accepted: November 4, 2011 became “milky” on the fourth postoperative day. Analysis of the fluid was compatible with chyle (milky color, protein, 3,400 mg/dL; triglycerides, 784 mg/dL; total cholesterol, 61 mg/dL; and lymphocyte dominance). Initially, we tried conservative management with closed suction drainage, a compressive ban- dage, and limitation of oral intake; however, the daily output of the drain increased to 700 mL by the seventh postoperative day. Therefore, we re-explored the axilla and observed that the clear fluid was running from a single duct located just below the lateral pectoral bundle branch (Figure 1). We ligated the duct and reinforced the suspicious site 3-4 cm below the duct using a mass ligature. After the re-exploration, the daily output of the drain decreased to 80 mL, although it remained slightly milky in nature. We removed the drain 9 days later. The path- ology report confirmed a 1.5-cm, poorly differentiated invasive ductal carcinoma and one metastatic lymph node of 15 lymph nodes evaluated. DISCUSSION Chylous leakage seldom occurs after axillary surgery because the axilla is anatomically remote from the thoracic duct. The reported incidence of chylous leakage after neck surgery is 1-3% and its incidence after surgery for breast cancer is ~0.5% [2,3]. To prevent and control this complication, it is important to determine the location of the chyle leakage. The anatomy of the thoracic duct is well documented and there are numerous vari- ations in the pattern and site of the thoracic duct in the venous © 2012 Korean Breast Cancer Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. http://ejbc.kr | pISSN 1738-6756 eISSN 2092-9900