• In the axillary lymph node dissection (ALND) procedure, only level 1/2 nodes are removed en bloc with the axillary fat pad.
• The axillary fat pad also contains the axillary vein, the thoracodorsal bundle, the long thoracic nerve, and medial pectoral nerves/vessels, which are all preserved in the procedure.
• The incision follows the underarm dimple, along the anterior axillary fold, following the axillary hairline.
• The clavipectoral fascia is incised to reveal the axillary fat pad.
• The axillary vein is carefully dissected and visualized at the superior border of the fat pad.
• The thoracodorsal bundle can be visualized by dissecting deep into the axillary fat pad.
• Revealing the latissimus dorsi muscle on the lateral border of the surgical field releases the thoracodorsal bundle from the fat pad.
• The long thoracic nerve lies medial to the thoracodorsal bundle, and can be palpated on the serratus anterior muscle.
• The axillary apex contains the level 2 lymph nodes, and can be better accessed by lifting the pectoralis minor muscle.
• Medial pectoral vessels/nerves should be preserved if possible in this dissection.
• While removing the fat pad, corner vessels/nerves at the inferior corner of the surgical field should be tied and ligated.

This animation was originally created as a Master's Research Project submitted in conformity with the requirements for the degree of Master of Science in Biomedical Communications (MScBMC), offered through the Institute of Medical Science, Faculty of Medicine, University of Toronto in collaboration with Biomedical Communications, Department of Biology, University of Toronto at Mississauga. Used with permission from the original author Albert Fung.