ALND can remove lymph nodes located below, above or underneath a muscle that runs along the side of the upper chest- this muscle is known as the pectoralis minor muscle.
There are three levels of axillary lymph nodes and possible solutions for a surgeon-
Level I — remove all the tissue below the muscle
Level II — remove the tissue directly underneath the muscle
Level III — remove the tissue that is above the muscle (this is the most aggressive surgery)
Cancer cells are usually removed from the breast at the same time as ALND.