Axillary Lymph Node Dissection (Levels I–II)

Procedure Snapshot

• Indication: Clinically positive nodes or failed SLNB.
• Expected duration: ___
• Special instruments: Nerve stimulator, retractor, LigaSure.

Step Workflow

1. Supine; arm abducted 90°.
2. Incision along axillary crease; raise flaps.
3. Identify axillary vein.
4. Remove fatty contents levels I–II.
5. Preserve long thoracic and thoracodorsal nerves.
6. Place drain.

Key Pimp Questions

• Q: Levels I–III?
  A: I lateral, II behind, III medial to pectoralis minor (PMID 28865216).
• Q: Lymphedema rate? ___ (PMID 31178992).
• Q: Z0011 trial implication?
  A: May omit ALND if ≤2 positive nodes.

Critical Anatomy

• Landmarks: Axillary vein, pectoralis minor.
• Danger zones: Thoracodorsal bundle, long thoracic nerve.

Informed Consent Highlights

• Risks:
  • Lymphedema ___
  • Nerve injury ___
  • Seroma ___

Post-op Considerations

• Drain care; early ROM.

References

• Chassin’s, Breast section.
• Clinical Scenarios, Breast chapter.
• NEJM Z0011 (PMID 21388309).