How do you address the axilla in an incidentally found T1bNx invasive breast cancer with extensive DCIS on bilateral prophylactic mastectomy in BRCA-2 mutated woman?

I would send her for an axillary ultrasound and biopsy any suspicious lymph nodes. Following a mastectomy, it is challenging to do a sentinel lymph node biopsy so surgical evaluation of the axilla usually requires an ALND. If by imaging the axilla is negative, I would run her tumor characteristics t...

If systemic treatment, would change because of nodal status, would favor an attempt to SNLN or ALND. If no change, then would favor no additional treatment to axilla.