This document defines the axilla and axillary dissection procedure. The axilla is bounded by the upper chest wall and arm. It contains lymph nodes, blood vessels, and nerves. Axillary dissection is performed during mastectomy or breast-conserving surgery when lymph node biopsy is not suitable. The surgeon makes an incision under the arm and removes at least 10 lymph nodes. Complications can include lymphedema, infection, and limited range of motion. Lymphedema is one of the most morbid complications and can be assessed by measuring both arms.

1. Axilla & Axillary
Dissection
Mohammed Suleiman Al Jajeh
20133422
Phase IV
NEAR EAST UNIVERSITY
HOSPITAL

2. Objectives
a. Define Axilla .
b. Give its boundaries and contents .
c. Axillary Dissection .

3. Gross

5. Axilla walls

13. Axillary artery
Branches
1st
part – 1
2nd
part – 2
3rd
part - 3

14. Branches of the axillary artery
1
Send - Superior thoracic artery
2
The - Thoraco-acromial artery
Lord to - Lateral thoracic artery
3
Say - Subscapular artery
A - Anterior circumflex humeral artery
Prayer - Posterior circumflex humeral artery

15. Axillary dissection

16. Background
Axillary dissection is a surgical procedure that incises
the axilla to identify, examine, or remove lymph
nodes.
Axillary dissection, either alone or with mastectomy
usually calls for general anesthesia
Cancer in the lymph nodes usually cannot be felt, so
doctors need to remove the lymph nodes and
examine them under a microscope to find out if they
contain cancer

17. Indications :
 Biopsy-proven metastatic
cancer
 clinically positive
lymphadenopathy in the
presence of a diagnosis of
cancer
 control of melanoma in
locations that may drain into
the axillary lymph nodes

18. When Axillary lymph node
dissection is Done ?
A. During a radical mastectomy .
B. With breast-conserving surgery .
C. When a lymph node biopsy is not suitable .

19. How ALND is done ?
a. ALND is done using general anesthesia in a
hospital operating room.
b. The surgeon makes an incision under the arm.
The surgeon usually removes at least 10 lymph
nodes .
After the lymph nodes are removed, a small tube
(drain) is placed in the incision  which reduces
the chance of swelling from fluid building up in
the tissue.
The drain is left in place for a few days
or until there is little drainage.

20. Gross

21. Related factors
I. Age at time of surgery
II. Body habitus (IBW)
III. Cardiac disease or diabetes
IV. Smoking history
V. Tumor size
VI. Number of nodes (Sometimes more than
10 lymph nodes are removed)

22. The complications
a) Postoperative seroma formation
b) Wound infection
c) Arm infections
d) Range of motion
e) Lymphedema
f) Numbness
g) Chronic pain
h) Axillary web syndrome

23. Seroma
 It’s the persistent drainage of axillary lymphatic
fluid .
 Cause : a result from transection of lymphatic
vessels, the use of electrocautery and local
inflammatory response .
 incidence of seroma formation ranges from 35%
to as high as 97% in breast cancer patients .

24. Lymphedema
One of the most morbid complications
Assessed by measuring both arms at the same site
Incidence varies from 5% to 80% .
Casues :
1. Due to injury to lymphatics and veins by surgery tumor
2. infiltration of lymphatics .
It’s usually responsive to compression therapy
Higher rates with increased BMI & Post Radiotherapy

25. Sensory -intercostobrachial
nerve
Conservation of the IBN, while anatomically
preferable, is not functionally necessary
during axillary dissection for breast cancer.
if it is not possible to dissect the nerve free
of tumor, then it can be sacrificed, which
results in the loss of sensation in the upper,
inner arm .

26. Axillary web syndrome
 Postoperative pain and limited range of motion
associated with a palpable web of tissue
extending from the axilla into the arm.
 Resolved in 2 – 3 months

28. Hint :
* The most common complication after
axillary dissection is Lymphedema .
* We did not measure the arm
circumference before surgery , because
changes in the extended follow-up period
are also dependent on weight loss and gain

29. Teşekkür ederim
References :
1.GRAY’S ANATOMY
2.ANNALS OF SURGERY
3.MEDSCAPE.COM
4.Canadian Cancer Society