Axillary Vein Fat Pad and Its Surgical Importance—Image of Interest

Axillary dissection is the best method to assess the lymph node status in breast carcinoma, but causes arm morbidity and lymphedema; this can be decreased by a careful dissection around the axillary vein. We have noted the presence of a constant tongue-like extension of the axillary fat pad over the axillary vein lateral to the pectoralis minor. Only one short reference in literature recommended complete removal of this fat pad, however we propose selective transection of the fat pad at the mid axillary vein level to limit damage to the lymphatics. The axillary vein is identified posterior to the fat pad with ease when it is mobilised completely or cut through transversely, when it protrudes superior to the axillary vein onto the brachial plexus. Sometimes a high level 1 lymph node can be found deep to the fat pad on the anterior aspect of the axillary vein, which should be removed along with other nodes.