Indocyanine green focused near-infrared fluorescence lymphography localization in treatment of chyle leak after mastectomy with targeted left axillary sentinel node biopsy for breast cancer

We present a woman in her 60s who underwent bilateral mastectomy with left axillary targeted lymph node biopsy in the setting of high grade invasive ductal carcinoma of the left breast with metastasis to a left axillary lymph node. Her postoperative course was complicated by high output milky drainage from her left axillary surgical drain, consistent with a chyle leak, after confirmatory testing demonstrated drain fluid with high triglyceride content. The patient failed non-operative management consisting of low-fat diet and compressive measures. Ultimately, the patient returned to the operating room where indocyanine green near-infrared fluorescence lymphography was used to localized damaged lymphatic channels, which were then ligated to resolve the leak. This report outlines a unique identification method of an unusual complication and serves to inform breast surgeons who may encounter this complication.