Indications

• Tumours < 4cm
• Mammogram excluding multifocal disease

Axillary clearance

1. Level I: Lateral to pectoralis minor
2. Level II: Up to medial border of pectoralis minor
3. Level III: Beyond medial border of pectoralis minor

Procedure

1. Curvilinear incision (including previous biopsy sites)
2. Incise around segment and deepen incision (maintain >1cm tumour clearance)
3. Separate breast tissue from pectoralis fascia
4. Remove tumour (insert silk sutures to identify parts of tumour)
5. Haemostasis + suction drains
6. Obliterate cavity
7. Close skin

Axillary clearance

1. Incise skin + elevate flaps superiorly/inferiorly
2. Identify lateral border of pectoralis major and anterior border of latissimus dorsi
3. Identify and divide pectoralis minor.
4. Preserve thoracodorsal (lat dorsi) and long thoracic nerve of bell (to serratus anterior). Preserve intercostobrachial nerve (axillary sensation)
5. Upper limit of dissection is axillary vein
6. Dissect contents away from vital structures, remove en masse.
7. Drain axilla with suction drain
8. Wash wound with antiseptic betadine + close subcutaneous tissues.

Complications

• Nerve injury (esp intercostobrachial nerve)
• Secondary lymphoedema
• Haematoma (avoided by diathermy + drains)