Axillary Lymph Nodes Dissection

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1- Introduction

2- Anatomical Overview

3- Procedure

4- purposes 


Axillary lymph node dissection (ALND) is a surgical procedure in which lymph nodes from the axilla (armpit area) are removed. This procedure is frequently performed on breast cancer patients to see how much the cancer has spread and to help guide further treatment decisions.
© image from color atlas of anatomy

Anatomical Overview

The axillary lymph nodes (20 to 30 in number) drain lymph vessels from the lateral quadrants of the breast, the superficial lymph vessels from the thoraco-abdominal walls above the level of the umbilicus, and the vessels from the upper limb.

The lymph nodes are arranged in six groups:

1-Anterior (pectoral) group: Lying along the lower border of the pectoralis minor behind the pectoralis major, these nodes receive lymph vessels from the lateral quadrants of the breast and superficial vessels from the anterolateral abdominal wall above the level of the umbilicus.

2-Posterior (subscapular) group: Lying in front of the subscapularis muscle, these nodes receive superficial lymph vessels from the back, down as far as the level of the iliac crests.

3- Lateral group: Lying along the medial side of the axillary vein, these nodes receive most of the lymph vessels of the upper limb (except those superficial vessels draining the lateral side—see infraclavicular nodes, below).

4- Central group: Lying in the center of the axilla in the axillary fat, these nodes receive lymph from the above three groups.

5- Infraclavicular (deltopectoral) group: These nodes are not strictly axillary nodes because they are located outside the axilla. They lie in the groove between the deltoid and pectoralis major muscles and receive superficial lymph vessels from the lateral side of the hand, forearm, and arm.

6- Apical group: Lying at the apex of the axilla at the lateral border of the 1st rib, these nodes receive the efferent lymph vessels from all the other axillary nodes.

© image from snell's clinical anatomy


  • Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
  • Incision: An incision is made in the axilla.
  • Dissection: Lymph nodes are identified and carefully removed.
  • Closure: The incision is closed with sutures or staples.
  • Purposes

    • Staging and Diagnosis: Determines if breast cancer has spread to the lymph nodes.
    • Treatment: Helps remove cancerous lymph nodes to prevent further spread of the disease.
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