On the other hand, drainages may cause pain, discomfort, restrict the mobility of the arm and increase the risk of secondary seroma infection, especially in cases with prolonged drain insertion. However, the standardized use of closed suction drains in wound management could decrease the incidence and degree of postoperative seroma formation following ALND significantly. Most approaches with the goal to reduce the risk of seroma formation including physiotherapy, external compression or the intraoperative use of hemostatic adhesives have failed. Further possible complications associated with ALND include hematoma, pain, cutaneous necrosis, wound infection and sequela like weakness of the upper arm, limited motion of the shoulder with or without stiffness, reduced grip strength, paresthesia and lymphedema. The most frequent surgical complication after axillary dissection is seroma formation with reported incidences between 18 and 74%. Patients after primary systemic therapy with pretherapeutic positive lymph node status in biopsy (cN1) and negative or positive lymph node status after systemic therapy (ycN0) should undergo axillary dissection. In cases with exclusive micrometastasistargeted axillary therapies including axillary dissection or irradiation is not indicated. After mastectomy or BCS without postoperative irradiation adjuvant axillary dissection or axillary irradiation should be performed. According to current breast cancer treatment guidelines patients with histological pT1-pT1/cN0-cancers and one or two positive sentinel lymph nodes, who underwent breast conserving surgery (BCS) and subsequently irradiation, should not be treated with axillary dissection. However, selected patients with locally advanced cancer with clinically positive axillary lymph nodes or macrometastasis in SLNB may still have an indication for ALND. For patients with breast cancer, SLNB is associated with fewer side effects when compared to ALND including postoeprative lymphedema and as a consequence offers better arm mobility and overall an improved quality of live. Multiple randomized clinical trials demonstrated that SLNB is a valid method for axillary lymph node staging as it reflects the overall axillary lymph node status with no significant differences in disease free survival and overall survival in comparison to ALND. in 1960 broke the dawn of a new era and mostly replaced conventional ALND as a standard procedure especially in early breast cancer. Sentinel lymph node biopsy (SLNB) which was first described by Gould et al. This approach also allowed axillary lymph node staging in patients with invasive breast cancer. Axillary lymph node dissection (ALND) used to be the gold standard to control local recurrence and to increase overall survival (OS) and was therefore conducted systematically. Likewise, the surgical approach to the axilla underwent significant changes in the last decades. Surgical therapy in breast cancer which is the most frequently diagnosed cancer in women worldwide has progressed over the centuries and became less radical and more focused on skin preserving and tissue sparing procedures. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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