For postmastectomy patients who have >2 sentinel nodes involved, would you recommend a completion axillary dissection or proceed with PMRT?

This is a question that is still debated. I am comfortable extrapolating AMAROS/Z011 to mastectomy patients despite the limited number of patients undergoing mastectomy in AMAROS.

In patients with 2-3 SLN involved (that were cN0), I would be ok with PMRT and omitting ALND as long as no ECE. If > 3 LN...

The rationale for dissection for > 2 node positive (clinical trials limiting to 1-2 node) is to some extent, based on the risk of additional node being high and RT may not be sufficient. Like in Z11 and AMAROS, the risk of additional nodes was 27-33% and for that subset, RT is sufficient. Recent Tin...