Once the subscapularis muscle is reached, dissection proceeds laterally back toward the latissimus dorsi muscle. A second nerve, the thoracodorsal nerve, is identified and preserved at this point. Injury to this nerve is also rare and is usually of no major significance. In rare cases, the thoracodorsal nerve is bound up with cancerous lymph nodes and needs to be sacrificed in order to remove them. This may cause some weakness in the latissimus dorsi muscle, but usually results in no noticeable deficit.
Care is taken during the axillary dissection to keep the axillary contents attached to the breast.
The surgeon will mark with a suture any areas of concern regarding proximity of the tumor to a margin. These areas will be immediately examined by the pathologist with frozen section, if necessary. As in a lumpectomy, areas of a close margin will be re-excised, even removing part of the pectoralis muscle, if necessary. The surgical field is irrigated with saline solution and searched carefully for bleeding vessels. If necessary, these are ligated or coagulated.