Now that breast surgeons at Beth Israel Medical Center in New York City have been using the Transmammary Axillary Lymph Node Evaluation, or TANE, procedure for two years, anecdotal evidence shows that patients who are appropriate for this procedure have a speedier and less painful recovery and better cosmetic results than patients who undergo the traditional sentinel node procedure through a second incision, according to Beth Israel’s Chief of Breast Surgery Susan K. Boolbol, MD. A follow-up study to put statistics to the anecdotal evidence is in the approval stage with Beth Israel’s Institutional Review Board.
TANE allows physicians to perform a sentinel lymph node biopsy, a procedure used to determine whether cancer has spread to areas beyond the breast, through a single incision in the breast, eliminating the need for an axillary incision to remove the lymph nodes. The standard procedure requires two incisions — in the breast and in the axillary. Surgeons perform the TANE simultaneously with the lumpectomy or partial mastectomy, using special instruments that guide them across the breast to the sentinel lymph node through the single breast incision. Frequently, physicians use this procedure when the cancer is in the upper outward quadrant of the breast near the axilla, where two incisions would be close together anyway. Dependent upon the location of the tumor, Boolbol says, TANE can be used in other parts of the breast as well.Mary Cahill, RN, a Beth Israel oncology nurse and Susan K. Boolbol, MD.
The advantages of TANE are reduced pain, hence a shorter recovery period; less risk of lymphedema; and less scarring. “We’ve done between 150 and 200 of these procedures here since 2006,” Boolbol says. “There really are no down sides to it, and patients have responded well.”
Experience shows that women undergoing the standard procedure, which still is necessary for patients who must have a full mastectomy, seem to experience more pain from the incision under the arm than from the breast incision. Boolbol says the reason is clear. “Every time you move your arm, the axillary area moves. The breast doesn’t move.” The surgery also may reduce the risk of lymphedema.
“Patients do seem happier with the results of this procedure,” agrees Mary Cahill, RN, a Beth Israel oncology nurse who works with Boolbol. “There are no special pre- or postop nursing considerations for these patients,” she says. “They get the same pre- and postop instructions and education as do patients undergoing the standard procedure.”
Nursing care includes but is not limited to pre- and postoperative patient/family teaching; reinforcing information about their diagnosis, surgical procedures, and any preoperative tests, evaluating the postoperative needs of the patients at home, and making referrals to other healthcare professionals, such as occupational therapy or social work, when needed. Patients are instructed to wear a supportive bra the day of the partial mastectomy, and, as with all surgery, to avoid aspirin, ibuprofen, or other blood thinners for seven days preoperatively. “We ask patients not to do any heavy lifting, pulling, or pushing for at least two weeks and possibly longer after surgery.” Cahill says. “We also advise them to use an ice pack to the area intermittently for the first 48 hours.”
When the patient comes in for the postoperative appointment, Cahill assesses the site for any surgical complications, removes and replaces the sterile strips, and, in some cases, removes sutures and drains. “I work alongside Dr. Boolbol when we see the patients,” Cahill says. TANE is an outpatient procedure, and Boolbol sees that as positive. “Patients always do better at home when it is an option.”
Boolbol and colleagues first reported on transmammary axillary lymph node evaluation in April 2006 at the 7th Annual Meeting of the American Society of Breast Surgeons, and published an article about it in The American Journal of Surgery in June 2006 (Am J Surg :478-480). They began using TANE at Beth Israel that August. Boolbol says that she and her colleagues are not the first to use the procedure but were the first to publish information about it in the biomedical literature.