ABSTRACT

The principal role of surgery is to excise, where possible, the entire primary tumour and to stage the extent of spread to lymph nodes. Seventy-five per cent of the lymphatic drainage of the breast is to the axillary lymph nodes. Accurate histopathological assessment of axillary lymph node involvement is the best predictor of survival from breast cancer. Surgeons may stage the axilla by sampling (removal of at least four lymph nodes) or partial staging (level I or level I and II dissection). The alternative is to stage and treat the axilla by a level III dissection (up to and including the apical group of nodes). More extreme (level III dissection) surgery has a higher rate of complications, however, the alternative combination of level II dissection with radiotherapy has a higher incidence of lymphoedema.