ABSTRACT
Axillary Dissection In cases of invasive carcinoma, axillary dissection to levels I, II, or III is carried out according to local protocols. This can be done through the upper end of the incision. The axillary vein and its tributaries are usually collapsed with the patient in the lateral position, and care must be taken to avoid inadvertent
damage. The subscapular, thoracodorsal, serratus anterior, and medial pectoral vessels are identified and preserved, together with the intercostobrachial, long thoracic, and thoracodorsal nerves. In cases of in situ disease, the dissection is limited to the lateral aspect of the axilla, identifying and preserving the main thoracodorsal trunk. Sentinel node biopsy is not
Figure 3 (A) A preoperative markup delineating tumor, resection margin, access tunnel, and S-shaped lateral incision. (B) Position of patient on the operating table showing fixation of hips and shoulder, and the position of the surgeon and the assistant. (C) Incision along lateral border of breast. (D) Separation of skin and subcutaneous tissues from underlying tumor-bearing quadrant. (E) Development of retromammary space, deep to pectoralis fascia. (F) Identification of anterior border of LD. (G) Distal and posterior division of LD before delivery of the flap. (H) Position of LD flap in resection defect after placement of sutures. (I) Schematic appearance of reconstruction following skin closure. (Continued).
