Intercostobrachial Nerve - Anatomical Considerations and its Importance in Carcinoma Breast of Female Patients

Background: Complete axillary node dissection is commonly performed in the management of breast cancer for oncological clearance as well as in the staging of the disease. The aim of the present study was to assess the beneficial effects of preservation of intercostobrachial nerve and its anatomical variation during the surgery (modified radical mastectomy and breast conserving surgery). Method: A total of 50 female patients with breast cancer underwent Muzamdar Cancer Centre of Narayana Hrudayalaya Hospital Bangalore between February 2010 and January 2012. For the purpose of ICBN preservation, the patients were randomly divided into two groups that is one with preservation of ICBN and one with non-preservation and intraoperative type of ICBN noted as classified by Cunnick et al. The numbness in area supplied by ICBN, paraesthesia in both the arms and assessment of pain by VAS score were recorded. Postoperative assessment was done 24 hours, 3 and 7days after surgery. Thereafter, reassessment was done after 1 and 6 months from day of surgery. Result: We have found all the six variants of ICBN as: Type I (40%), type II (24%), Type III (14%), Type IV (4%) Type V (6%) and Type VI (12%). At 1 month all the patients in both the groups did not complained numbness and paresthesia (p=1.00). At 6 months (80%) in non preserved group had numbness as compared to (20%) in preserved group of ICBN (p<0.001), similarly (75%) in non-preserved group had paresthesia as compared to (25%) in preserved group of ICBN after 6 months (p = 0.004) which shows that both numbness and paresthesia are significantly decreased over a period of time in preserved group of ICBN. There was significant decrease in pain in preserved group of ICBN after 6 month versus nonpreserved group of ICBN (p<0.001). Local relapse was not observed in any group after 36 months of follow-up. Conclusion: As per our knowledge, this is the first study which describes the various anatomical variants encountered during axillary clearance surgery. Our study shows that the morbidity resulting from division of the ICBN during axillary surgery is significant. Preserving ICBN significantly reduces paraesthesia, numbness and pain.