Identification rates of ARM nodes can be improved by injecting the blue dye in the upper medial aspect of the arm at the time of induction. Majority of the arm nodes lie between the axillary vein and the first intercostobrachial nerve. It is difficult to preserve the ARM nodes in patients of LABC, who have had good response to NACT and in patients of LABC with poor response to NACT, the incidence of metastasis in ARM nodes is quite high. Therefore, ARM is not a feasible option in patients with locally advanced breast cancer.

This case illustrates the potential benefit of utilizing autologous ALT perforator flap in a girl with Poland's syndrome with a deformed chest wall with hypoplasia of pectoral muscles and absence of the anterior axillary fold which makes positioning of an implant difficult. Breast reconstruction using a microvasular perforator flap is an alternative method to restore the contour of the chest and breast without the use of an implant.

Breast cancer presenting in the midline of the chest and without a primary focus in the breast is extremely rare. A 48 year old post-menopausal lady presented with a rapidly enlarging lump over the middle of her chest along with bilateral axillary lymph nodes. Clinical and imaging tests failed to demonstrate a focus of cancer in either of the breasts. Incisional biopsy of the lesion revealed it to be an infiltrating ductal carcinoma. As no guidelines exist to manage such patients, she was started on neo-adjuvant chemotherapy. Following a good response to chemotherapy, she underwent wide local excision of the lesion with bilateral axillary lymphadenopathy. She subsequently received adjuvant chemotherapy, radiotherapy and hormonal therapy.