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The extent of axillary dissection has changed over time according to the evolution in understanding breast cancer characteristics. The first complete axillary lymph node dissection (ALND) was described in 1894 by Halsted in his reports on the technique for “radical mastectomy”; in the “Halsted hypothesis”, in which breast cancer was considered a local disease, ALND was intended to be curative [1].

A century of breast cancer surgery has seen the evolution of a number of techniques for the surgical treatment of breast carcinoma by surgery. New knowledge of the natural history of breast carcinoma, the introduction of adjuvant therapies and increasingly early diagnosis have naturally led to a change in surgical treatment. The principal stages along this pathway have basically been three. First, the entity of surgical demolition has been reduced as well as the morbidity associated with it. From Halsted’s radical mastectomy, through the variants proposed by Patey and Madden, we arrived at the removal of the glandular structure only, with dissection of axillary lymph nodes. Crile’s studies in the sixties demonstrated the systemic nature of the disease, disproving Halsted’s principle of en bloc removal of suspect tissue, and thus opening the door to conservative surgery [1].