Axillary Management in Breast Cancer

Breast cancer is the most common malignancy worldwide and is on the rise in India. The surgical management of breast cancer includes removal of breast cancer and ipsilateral axillary lymph node dissection (ALND). Axillary management is an integral pivotal part of the breast cancer management. Complete axillary dissection was considered to be a mandatory part of the surgical care of breast cancer until the 1980s. Recently, several factors, such as small, nonpalpable, mammographically detected breast lesions with a low risk of nodal metastasis, greater awareness of the complications related to ALND, and the current practice of providing adjuvant chemotherapy to patients with breast cancers >1 cm, regardless of axillary lymph node status, have lead the practitioners to reconsider the role of routine axillary dissection in the treatment of breast cancer. It has evolved from axillary lymph node dissection to sentinel lymph node biopsy with or without radiotherapy in patients undergoing upfront surgery. Several landmark trials (NSABP B-04, B-32, AMAROS, Z-0011) have proved that axillary surgery does not affect the overall survival of patients. ALND is associated with a variety of complications, such as lymphedema of the arm, pain/anesthesia/paresthesia of the arm and shoulder region, seroma formation, infection, and restriction of shoulder movements; therefore, sentinel lymph node biopsy is a minimally invasive alternative to ALND.