Implantation along the Access Tract after Bilateral Axillo-Breast Approach Thyroidectomy: A Rare Complication in Minimally Invasive Surgery

Bilateral axillo-breast approach (BABA) is a minimally invasive, remote access technique that utilises small incisions in the axillae and periareolar regions. Its outcomes are comparable to open thyroidectomy with similar complication rates. However, there is a theoretical risk of “tract seeding” or “subcutaneous thyroid tissue implantation” after these techniques, predominantly the transoral approach. A 17-year-old male presented with a progressive anterior neck swelling for 9 months. Ultrasonography (USG) of the neck revealed a TIRADS 3 nodule (4.8 cm × 4.0 cm) in the left thyroid lobe, and fine-needle aspiration cytology was classified as Bethesda Category V. The patient underwent total thyroidectomy with BABA. Histopathological examination revealed a unifocal invasive follicular thyroid carcinoma in the left thyroid lobe, pathological Stage pT3a (AJCC eighth edition). Whole-body radioiodine scan (WBRI) scan after thyroxin withdrawal showed residual tissue in the thyroid bed and thyroglossal duct. Multiple focal areas of increased uptake were noted in the anterior chest wall along the pectoral muscle along the surgical access path. The patient received 100 mCi of high-dose radioiodine (I-131) therapy.