Effect of Intercostobrachial Nerve Preservation During Axillary Dissection in Breast Cancer Surgery: A Prospective Cohort Study

Background: The intercostobrachial nerve (ICBN), originating from the lateral cutaneous branch of the second intercostal nerve, innervates the axilla, lateral chest, and medial arm. Injury to the ICBN during axillary lymph node dissection (ALND) is associated with postoperative sensory disturbances. ICBN preservation is not routinely performed but may reduce pain and sensory disturbances in the ipsilateral arm. The objective is to determine the differences in postoperative clinical outcomes—specifically pain, paresthesia, and anesthesia of the ipsilateral arm—between patients who underwent ICBN preservation and those who did not, and to analyze anatomical variations of the ICBN within the study population. Methods: This prospective cohort study was conducted at the Breast and Sarcoma Unit of the Regional Cancer Centre, Thiruvananthapuram, India, from January 2021 to March 2022. Evaluations were conducted preoperatively and on designated postoperative days for patients in both the ICBN preservation and no-preservation groups. Results: Among the 147 patients who underwent axillary dissection, 29 (20%) had the ICBN preserved. At 180 days postoperatively, 86.2% of the patients in the ICBN preservation group were asymptomatic compared with 54.4% in the ICBN sectioned group. Sensory disturbance or pain was reported in only 13.8% of the ICBN preservation group vs 45.6% in the ICBN sectioned group. The incidence of pain, paresthesia, and anesthesia of the ipsilateral arm was significantly lower with ICBN preservation. Conclusion: ICBN preservation during axillary dissection may reduce postoperative sensory disturbances in the superior medial region of the arm.