Breast

Axillary Lymph Node Clearance (Axillary Dissection)

AXILLARY LYMPH NODE CLEARANCE (AXILLARY DISSECTION)

Indication: Confirmed axillary lymph node involvement (positive sentinel node biopsy meeting criteria for clearance, or clinically node-positive axilla after neoadjuvant chemotherapy). Levels I and II routinely cleared; Level III added for macroscopic nodal involvement.

Patient Position: Supine, arm extended at 90° on arm board.

Anaesthesia: General.

Procedure:
1. Separate transverse axillary incision (if not part of mastectomy).
2. Axillary fat pad exposed and dissected.
3. Axillary vein identified along the superior boundary — nodal tissue dissected off its inferior border.
4. Level I nodes cleared (lateral to the pectoralis minor).