Patient s/p mastectomy with sentinel node biopsy and tram flap.now with recurrent cancer. would anyone do repeat sentinel node biopsy?

Depends: Is the recurrence on the same side or contralateral breast? If on contralat then yes do a sln bx. If its an axilary recurrence then do an axillary dissection. If its in the chest wall on the side of the tram then probably do an axillary dissection since the lymphatics will have been disrupted with the original surgery.

Where is the : Recurrence? If it is distant mets, definitely no. If it is local recurrence, probably not. She needs systemic treatment in addition to local excision and xrt. I think sentinel node is useful in initial staging, but i think your patient needs systemic therapy regardless of present nodal involvement. Does that make sense?

Yes: There are studies that show a repeat sentinel node biopsy can be performed but it certainly would depend upon what type of incision was used for the mastectomy.