The axilla is bordered by the axillary vein superiorly, the serratus anterior muscle medially, the latissimus dorsi muscle laterally, the subscapularis and teres minor muscles posteriorly, and the pectoralis major and minor muscles along with the subclavius muscle and clavipectoral fascia anteriorly.
Make an incision below the axillary hairline (if using separate incision). This can be performed using a slightly S-shaped incision along the pectoralis muscle and along the latissimus dorsi muscle.
Incise the clavipectoral fascia to expose the axillary tissue.
Define the pectoralis muscles and preserve the medial pectoral neurovascular bundle.
Identify the latissimus dorsi muscle.
Carefully dissect superiorly along the latissimus dorsi muscle to visualize the axillary vein.
Identify the long thoracic nerve along the serratus anterior muscle and thoracodorsal neurovascular bundle along the latissimus dorsi muscle.
Identify the intercostobrachial nerves and preserve them if possible.
Once the neurovascular bundles and axillary vein have been identified, complete the dissection and excise all nodal tissue (levels I and II).
Typically, leave a negative pressure drain in the axilla.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
