A patient underwent breast conservation surgery for 3 cm lesion along with sentinel lymph node biopsy., which showed one-third of sentinel lymph nodes are positive for macrometastasis. Next step is

Lymphatic metastasis in Carcinoma Breast: Lymphatic spread in CA breast occurs through subareolar lymphatic plexus of Sappey&;s lymphatic plexus, cutaneous lymphatics & inflammatory lymphatics. Lymphatic metastasis occurs primarily to the axillary (75%) & internal mammary lymph nodes. Tumors in the posterior one-third of breast are more likely to drain to the internal mammary nodes. Involvement of LNs has both biological & chronological significance It represents not only an evolutional event in the spread of the carcinoma but is also a marker for the metastatic potential of that tumor Involvement of supraclavicular nodes and of any contralateral lymph nodes represents advanced disease, LN metastasis is treated by surgical dissection and radiotherapy Axillary Lymph node levels in relation with pectoralis minor Level Relation with pectoralis minor Axillary LNs included I Below or lateral Anterior, Posterior, Lateral II Posterior (behind) Central, Interpectoral (Rotter&;s nodes) III Medial or above Apical Ref: Sabiston 20th edition Pgno: 853