Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery

Abstract

The preservation of the ICBN significantly improved the functional effect of the axillary dissection for breast cancer by reducing sensory loss, while there was no difference in pain intensity and duration. Although we did not prove that the preservation of LTV prevents breast edema after conservative surgery for breast cancer, we think that more complex analysis, including parameters such as the extent of resection of breast tissue, the dimension and constitutional characteristics of the breast, tumor location, obesity, and further developments in surgical technique, would reveal at least discrete improvements in the functional results of this surgical approach.

Anatomical variations of the axilla

“…Freeman et al (2003) demonstrated that a possible sensory loss in the arm after sectioning the ICBN was usually transitory. However, several studies, including a meta-analysis, have demonstrated a significant sensory benefit when the ICBN is preserved (Ivanović et al 2007; Warrier et al 2014). Based on the findings of the present study, should be considered the hypothesis that the extent and severity of sensory loss in the arm are directly proportional to the size of the lesion caused in the ICBN, which remains to be confirmed in future studies.…”

New anatomical classification of the axilla with implications for sentinel node biopsy

“…It traverses the axilla obliquely, lying within the axillary fat pad where it gives cutaneous branches to the floor of the axilla. It then communicates with the medial cutaneous nerve of the arm (arising from the brachial plexus) and pierces the deep fascia supplying the skin on the medial side of the upper arm17, 31–33.…”

Evaluation of the harmonic scalpel in breast conserving and axillary staging surgery

“…The loss of sensitivity was significantly lowered when the ICBN was preserved. 20 Axillary numbness was commonly seen after an ALND, but much less frequently after an SLNB. 21 This morbidity was due to not sparing the ICBN when performing the ALND.…”