Axillary lymph node clearance: overcoming the technical difficulties

Background: Complete axillary clearance is recommended as part of the treatment in selected patients with invasive breast cancer. There are a number of potential technical difficulties in performing level III axillary clearance including: the deep and high position of level II and III nodes, their close proximity to the axillary vein, the difficulty in adjusting the operating light to illuminate the different levels of the axilla and the need for at least one assistant to perform the procedure. Aim of the study: To evaluate a new axillary clearance retractor, which is designed to overcome the technical difficulties in axillary clearance. Patients and methods: The retractor was used for level III axillary clearance in 30 patients with invasive breast cancer either as part of total mastectomy (16 patients) or breast conservation surgery (14 patients). The retractor is table-based and provides simultaneous illumination to all levels of the axilla via light bundles. It has a long L-shaped component to retract the pectoral muscles and a self-retaining component to retract the skin edges. Assistants were not required in all patients. The details of the retractor and technique is described and literature reviewed. Results: The mean age of patients was 54 years (range 46–83) and the mean tumour size was 24.9 mm (range 11–70). The mean number of total lymph nodes removed was 19.4 nodes (range 11–50). The mean number of lymph nodes identified in level III dissection was 2.4 nodes (range 0–8). Six patients developed axillary seroma, which was treated by aspiration. Conclusion: The axillary clearance retractor can be used with ease and without complications. It helps to overcome the technical difficulties in this operation.