Technique of axillary lymph node dissection
- Julie Margenthaler, MD
Julie Margenthaler, MD
- Associate Professor, Division of General Surgery, Endocrine and Oncology Surgery
- Washington University School of Medicine
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Evaluation of the axilla provides information for treatment decisions in patients with invasive breast cancer. Axillary lymph node dissection is the standard initial approach for breast cancer patients who are clinically node positive. Sentinel node biopsy is the standard initial approach for patients with early stage breast cancer who are clinically node negative.
The technique of axillary lymph node dissection (ALND) will be reviewed here. The approach to management of the regional lymph nodes in breast cancer, sentinel node biopsy indications and outcomes, sentinel node biopsy techniques, and the effect of ALND on patient survival are discussed elsewhere. (See "Management of the regional lymph nodes in breast cancer", section on 'Axillary dissection' and "Diagnosis, staging and the role of sentinel lymph node biopsy in the nodal evaluation of breast cancer" and "Sentinel lymph node biopsy in breast cancer: Techniques" and "Management of the regional lymph nodes in breast cancer", section on 'Impact of ALND on survival'.).
An axillary lymph node dissection (ALND) is performed with the primary breast procedure (eg, lumpectomy or mastectomy) in patients who have:
●Locally advanced (T4a, b, c) or inflammatory breast cancer. (See "Diagnosis, staging and the role of sentinel lymph node biopsy in the nodal evaluation of breast cancer".)
●Needle-biopsy-proven metastatic disease in axillary lymph node(s), which are either clinically palpable or nonpalpable but abnormal by imaging (mostly ultrasound) criteria. (See "Diagnosis, staging and the role of sentinel lymph node biopsy in the nodal evaluation of breast cancer".)
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- SURGICAL ANATOMY
- Borders of the axilla
- Contents of the axilla
- - Motor nerves
- - Sensory nerves
- - Lymph nodes
- - Blood vessels
- PREOPERATIVE PREPARATION
- SURGICAL TECHNIQUE
- Critical steps of the dissection
- Axillary reverse mapping
- POSTOPERATIVE CARE
- SUMMARY AND RECOMMENDATIONS