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Chapter 15: Breast Surgery

The long thoracic nerve

(A) Innervates the latissimus dorsi muscle

(B) Arises from the posterior cord of the brachial plexus

(C) Is located deep to the axillary artery and vein and then travels superficial to the deep fascia of the serratus anterior muscle

(D) Is also called the internal respiratory nerve of Bell

(E) Has minimal significant sequelae if damaged during axillary dissection

(C) The anatomy of the axilla is shown in Fig. 15-3. The long thoracic nerve, or the external respiratory nerve of Bell, arises from the fifth, sixth, and seventh cervical nerves and passes deep to the axillary artery and vein, staying close to the chest wall. It innervates the serratus anterior muscle. This muscle is important in stabilizing the scapula on the thorax. Injury to the long thoracic nerve results in a winged scapula. This can lead to significant morbidity.



FIGURE 15-3. Axillary nerves. Reproduced with permission from Petrek JA, Blackwood MM. Axillary dissection: current practice and technique. Curr Prob Surg. 1995;32:285.


The thoracodorsal nerve arises from the posterior cord of the brachial plexus and passes beneath the axillary vein. It runs in the posterior axilla and through the areolar tissue containing the lymph nodes. It innervates the latissimus dorsi muscle. Loss or injury of the thoracodorsal nerve results in weakness of extension, internal rotation, and adduction of the humerus. This can be well tolerated by most patients.



Osbourne M. Breast anatomy and development. In: Harris JR, Lippman ME, Morrow M, et al. (eds.), Diseases of the Breast, 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:6–9.

Spratt J, Donegan W, Tobin G. Gross anatomy of the breast. In: Donegan W, Spratt J (eds.), Cancer of the Breast, 5th ed. St. Louis, MO: W.B. Saunders; 2002:32–37.

Axillary lymph nodes are classified according to the relationship with the

(A) Axillary vein

(B) Pectoralis major muscle

(C) Pectoralis minor muscle

(D) Axillary nerve

(E) Serratus anterior muscle

(C) The axillary lymph nodes are classified according to their relationship with the pectoralis minor muscle (see Fig. 15-4).



FIGURE 15-4. Axillary node levels. Used with permission from Visual Art © 2012. The University ...

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