Postoperative Axillary Chyle Leak Following Modified Radical Mastectomy with Level III Axillary Dissection: A Rare Case Report of a Complication Managed Conservatively

Abstract

Introduction: Chyle leak after axillary lymph node dissection is a rare postoperative complication that may occur after injury to the thoracic duct or its aberrant tributaries. Early recognition is important because persistent chyle loss may contribute to nutritional, metabolic and wound-related morbidity. Case Presentation: A 64-year-old postmenopausal woman with carcinoma of the left breast received neoadjuvant chemotherapy followed by left modified radical mastectomy with level III axillary clearance. The immediate postoperative period was uneventful. After oral feeding was initiated, the drain output became milky white on postoperative day 2 and measured approximately 790 mL. Drain fluid triglyceride was 237 mg/dL, supporting the diagnosis of chyle leak. The patient was managed conservatively with a fat-free diet, axillary pressure dressing, continued negative suction drainage and serial monitoring. Drain output progressively decreased and became minimal and serous by postoperative day 14, allowing safe drain removal without surgical re-exploration. Final histopathology showed residual mucinous cystadenocarcinoma of the breast, with free surgical margins and three positive nodes among 51 retrieved lymph nodes. The patient was disease-free at the 3-month follow-up. Conclusion: This case illustrates that postoperative axillary chyle leak can occur after left-sided level III axillary dissection and may resolve with timely conservative management in a clinically stable patient.