MRCS Review – Anatomy Q3


The clavipectoral fascia is situated under the clavicular portion of pectoralis major. It protects both the axillary vessels and nodes. During an axillary node clearance for breast cancer the clavipectoral fascia is incised and this allows access to the nodal stations. The nodal stations are; level 1 nodes inferior to pectoralis minor, level 2 lie behind it and level 3 above it. During a Patey Mastectomy surgeons divide pectoralis minor to gain access to level 3 nodes. The use of sentinel node biopsy (and stronger assistants!) have made this procedure far less common.


Boundaries of the axilla

MediallyChest wall and Serratus anterior
LaterallyHumeral head
Anterior aspectLateral border of Pectoralis major
FasciaClavipectoral fascia


Long thoracic nerve (of Bell)Derived from C5-C7 and passes behind the brachial plexus to enter the axilla. It lies on the medial chest wall and supplies serratus anterior. Its location puts it at risk during axillary surgery and damage will lead to winging of the scapula.
Thoracodorsal nerve and thoracodorsal trunkInnervate and vascularise latissimus dorsi.
Axillary veinLies at the apex of the axilla, it is the continuation of the basilic vein. Becomes the subclavian vein at the outer border of the first rib.
Intercostobrachial nervesTraverse the axillary lymph nodes and are often divided during axillary surgery. They provide cutaneous sensation to the axillary skin.
Lymph nodesThe axilla is the main site of lymphatic drainage for the breast.


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