E.I. Sigal, R.G. Khamidullin. Lymphatic drainage from the mammary gland is known to occur in the axillary, subscapular, and subclavian lymph nodes, as well as in the retrosternal lymph nodes. Studies of the lymphatic system and clinical observations have shown that with medial and central tumor locations, parasternal lymph node involvement is possible, due to the peculiarities of lymphatic drainage from the internal quadrants of the mammary gland. The current interest in the parasternal lymph nodes is not accidental, as metastatic involvement is detected in 16-60% of cases of extended mastectomies. Therefore, parasternal lymphadenectomy is a mandatory stage of surgery for medial and central breast cancer. Indication: medial and central breast cancer. Contraindications: general contraindications to TO. Topographic anatomy. The retrosternal lymph nodes located along the internal mammary vessels from the 2nd to 4th intercostal spaces are removed (Fig. 1). The size of the retrosternal lymph nodes ranges from 0.3 to 1 cm, and their number ranges from 2 to 6. Surgical technique. After induction of anesthesia, the trachea is intubated with a double-lumen Carlens tube. A wedge-shaped cushion is placed under the chest on the side of the operation, using which the patient is placed in a position intermediate between the supine and lateral positions. After completion of breast surgery (medial radical resection, mastectomy according to Patey, Maden, Halsted), the anesthesiologist excludes the lung on the side of the operation from the act of respiration. The first thoracoport is inserted into the 5th intercostal space along the midclavicular line, the second into the 4th intercostal space along the axillary line, and the third into the 5th intercostal space along the midaxillary line (Fig. 2). The pleural cavity is inspected, then the parietal pleura is dissected parallel to the internal mammary vessels at the level of the 1st to 4th intercostal spaces (Fig. 3). In the 1st intercostal space, the internal mammary artery and vein are clipped and divided (Fig. 4). The fatty tissue with lymph nodes located along the vessels is isolated up to the level of the 4th intercostal space, where the internal mammary vessels are again clipped and divided (Fig. 5). The specimen is removed. The manipulation area is washed with isotonic sodium chloride solution, small bleeding vessels are coagulated (Fig. 6). The pleural cavity is sanitized and a drain is inserted under visual control. The lung is inflated, and the surgical wound is sutured. Postoperative care is no different from standard care after radical mastectomy. The drain from the pleural cavity is removed 2-3 days after surgery, after the exudation has ceased.