Current surgical standards in the management of the axilla

Summary Axillary surgery in breast cancer has undergone a profound transformation in recent decades. While axillary lymph node dissection (ALND) was the unquestioned standard until the 1990s [1], associated morbidity including lymphedema rates as high as 25% in the affected arm [2], led to the widespread adoption of sentinel lymph node biopsy (SLNB). Recent data now suggest that even SLNB may be safely omitted in selected low-risk patients. This article reviews the evolution of axillary management, summarizes pivotal evidence from the INSEMA, SOUND and BOOG 13-08 trials, and discusses the clinical implications, limitations, and future directions of this ongoing de-escalation process.