A transverse pike or oblique pike incision that includes the nipple is usually chosen. Figure 2 Anatomy of the axilla Axillary lymph node dissection has always been considered part of the standard surgery for invasive breast cancer. Its purpose is not only to remove the metastatic lymph nodes, but also to understand the status of the axillary lymph nodes in order to determine the staging and choose the best treatment plan. According to Berg’s axillary lymph node grading criteria, Level I is the anterior border of the latissimus dorsi muscle to the lateral border of the pectoralis minor muscle, Level II is the lateral border of the pectoralis minor muscle to the medial border of the pectoralis minor muscle, and Level III is the medial border of the pectoralis minor muscle to the entrance of the axillary vein (Halsted’s ligament). Jumping metastases with negative Level I and II and positive Level III are rare, only 3%, and negative Level I and positive Level II have been reported. Most scholars now believe that clearing all lymph nodes of Level I and Level II is necessary and does not affect the local control rate, and the recurrence rate of axillary lymph nodes is only 3%. Figure 3 Preservation of important axillary anatomical structures Preservation of important axillary structures: long thoracic nerve, thoracodorsal nerve, axillary vessels, and thoracodorsal vessels.