Completion Axillary Lymph Node Dissection (cALND) in Residual Axillary Disease After Modified Radical Mastectomy

Residual axillary disease after an incomplete axillary lymph node dissection in breast cancer poses a management challenge. We report a 46-year-old female with left breast invasive ductal carcinoma who presented two months after modified radical mastectomy with bulky residual axillary nodes. PET-CT revealed metabolically active nodes suspicious for metastasis. After multidisciplinary discussion, completion axillary lymph node dissection (cALND) was performed, yielding two metastatic nodes out of six. The postoperative course was uneventful, and the patient proceeded to systemic therapy. For limited residual disease, regional nodal irradiation plus systemic therapy may achieve comparable local control with reduced morbidity, whereas bulky disease may justify surgical clearance for accurate staging and local control. This case highlights the role of cALND in young patients with significant residual nodal disease, emphasizing individualized, multidisciplinary decision-making based on disease burden, radiation quality, and systemic therapy.