Parasternal lymph nodes are also one of the metastatic pathways of breast cancer. In more than 2000 cases of breast cancer at the Cancer Hospital of Fudan University, pathological analysis revealed that the metastasis rate of internal breast lymph nodes reached 15%, especially in clinical cases of stage IIb or III when the lesions were located in the medial or central part of the breast. In stage III breast cancer patients with pathologically confirmed metastasis in the axillary lymph nodes, the rate of metastasis in the internal breast lymph nodes reached 25%. Turher-wcawick reported that one-fourth of the lymphatic flow of the breast converges to the parasternal lymph nodes, and if cancer cells remain in the breast or regional lymph nodes, it will directly affect the prognosis. Therefore, many scholars advocate the removal of parasternal lymph nodes, including the pleura, to contour the supraclavicular lymph nodes in order to improve the survival rate after surgery, which is widely used in progressive or medial breast cancer cases. There are many surgical methods for internal breast lymph node removal, usually the whole quick excision method (en bloc method) 2, excision of the large and small chest muscles, excision of 4, 3, 2 rib cartilage and intercostal muscle block. Or partial excision of the sternum and block excision of the cartilage of 4, 3, 2 ribs and intercostal muscles. The surgery is more invasive. We use to preserve the pectoralis major and minor muscles, cut the pectoralis major muscle fibers, remove the rib cartilage of the 2nd, 3rd and 4th ribs, expose the intramammary vessels between the 1st and 4th ribs, remove the lymphatic vessels and fatty tissue around them, and keep the pleura intact. Its surgery is less invasive and can even be applied to breast cancer breast-conserving resection. Internal breast lymph node metastasis is most closely related to the site of breast cancer, and metastatic cancer in the medial and central regions of the breast is the most common, with the medial side accounting for more than 50%. Morrow and Foster suggested that internal breast lymph node dissection should be performed in the following patients: 1) Patients who are likely to receive chemotherapy; 2) Patients whose primary cancer is located in the medial quadrant of the central region, or in the lateral quadrant with tumors larger than 2 cm; 3) Patients with ACND with high suspicion of metastatic lymph nodes and positive intraoperative freezing. Internal breast lymph node removal has also been proposed for patients with advanced breast cancer.