The axillary lymphatic vessels drain the breast, chest wall, arm, and shoulder into the axillary lymph nodes (levels I, II, III defined by their relationship to the pectoralis minor). The lateral group drains the arm, the anterior (pectoral) group drains the breast, and the posterior group drains the scapular region.
The axillary lymphatics are the primary route of breast cancer metastasis. Sentinel lymph node biopsy (SLNB) identifies the first draining axillary node using blue dye and/or radioactive tracer. Level I-III axillary clearance for positive sentinel nodes removes the lymphatic drainage pathway. Lymphoedema of the arm is the major morbidity of axillary lymph node dissection, caused by disruption of the arm lymphatic drainage.
Arm lymphoedema from axillary lymph node dissection and lymphatic vessel disruption in breast cancer surgery, producing chronic arm swelling managed by compression garments, manual lymphatic drainage, and lymphaticovenous anastomosis.
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