The role of internal mammary chain lymph node removal in breast cancer is still not clarified. Although it has been proven that elective dissection of the internal mammary chain nodes does not improve survival, their selective treatment based on sentinel lymph node biopsy is under evaluation. There is another possibility to establish the status of internal mammary chain nodes--sampling of the nodes during the preparation of the site for microvascular anastomosis to the internal mammary artery and vein for free flap transfer. From August 2002 to December 2003, 54 free flaps were performed for breast reconstruction. In 11 cases, an internal mammary chain lymph node was harvested. A positive internal mammary chain node was found in only one case. In this case, the treatment policy was changed by adding irradiation to the internal mammary chain. The sampling of internal mammary chain nodes during preparation of the site for microvascular anastomosis to the internal mammary artery and vein should be a part of the reconstructive procedure after total mastectomy for invasive breast cancer because it could change the treatment plan.
