Introduction and Objectives: Born in 1957, our female patient presents with a history of bilateral invasive breast cancer, first in 2008 in the Right breast and 10 years later in the left breast, treated by Mastectomy and axillary dissection of both breasts with axillary node positive disease and clear margins of the initial Right Breast and negative axillary nodes and clear margins in the Left breast. In 2022, 4yrs after her second (Left) Mastectomy she presented with seven palpable axillary nodes and was treated by Axillary surgery demonstrating Invasive ductal breast carcinoma in all 7 axillary nodes. Were appropriate treatment protocols applied based on established guidelines to prevent progression to nodal metastasis from the Left Breast Cancer?
Methodology: We reviewed the literature on recommended protocols to determine if appropriate treatment guidelines were applied in our case. Further critique of the management is pursued in light of this literature review.
Conclusion: Published treatment guidelines appear to have been applied in this case. Yet the ultimate outcome was unexpected. We discuss possible reasons for this as well as whether consideration should be given to changing our therapeutic approach in such cases

Keywords:Invasive breast cancer; Axillary surgery in breast cancer; Adjuvant breast cancer treatment; Treatment of axillary nodes