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Axillary node dissection is usually recommended for invasive breast cancer. It is a good idea for you to meet with your surgeon to carefully weigh the risks and benefits before choosing this procedure.
Lymph nodes are small groups of tissue that filter your body fluids. The lymph nodes in your underarm - also known as axillary lymph nodes - filter the fluid that comes from your breast. The axillary node dissection is a test to determine if your cancer has spread from the breast. It is a surgical procedure that is not curative - but rather helps provide a detailed diagnosis. A specific amount of fat tissue (containing the nodes) is removed from under the arm of your affected breast.
Many surgeons today (in 1995) use lymph node dissection to help them choose the best systemic treatment for you.
Caption: Underarm lymph nodes.
Deciding whether or not to remove lymph nodes for examination depends on the pathological analysis of lumps removed from your breast. Axillary node dissection is a way to see if your cancer has spread beyond your breast, and gives health care providers the best idea of how they can treat your cancer most effectively.
A common temporary side effect after surgery is limited arm movement and feeling tightness under your arm.
To improve the motion of your arm, (also called your range of motion), you will be given special stretching exercises. It is important to do these stretches when they are recommended, or you may risk losing that range of motion permanently.
Caption:
"Wall Walking" is a common range of motion exercise.
It is important to understand that a permanent side effect of this procedure is a greater risk of infection in your arm, after the lymph nodes have been removed. You should take special care of that arm and hand, and avoid activities that could injure it. Be protective but not paranoid Ñ you want to reduce your chances of getting an infection. Don't lift or carry heavy things with your arm lowered (like a suitcase or large package) and avoid using a shoulder strap for bags or purses on your affected side. If you do get an infection, get to your health care provider as soon as possible and have it treated. You can identify an infection by tenderness, warmth of the tissue, or a cut that drains fluid.
There is a also a nerve that goes through the middle of the area where you have your lymph node dissection. This nerve does not affect how your arm moves, but it does affect sensation under your arm. Many surgeons must cut the nerve (it's difficult to save), and if it is cut, you will permanently lose some sensation in the back part of your underarm.
Caption:
The nerve.
The most serious side effect of an axillary lymph node dissection is luckily rare. It occurs in about 3% of women. The condition is called lymphedema - the swelling of your arm and hand caused by decreased lymph flow.
Normally, the lymph nodes under your arm filter bacteria out of the lymph fluid, that travels up and down your arm. After surgery, scar tissue may block the flow of the lymph fluid through the underarm area, the drainage slows, and your arm swells. The swelling can be minor, (your hand may feel slightly swollen), or major (more rarely your arm becomes quite large).
Caption:
Scar tissue can block the flow of lymph fluid up and down your arm, making your arm swell.
Lymphedema can occur in varying degrees. Some women with ongoing lymphedema wear an elastic sleeve to improve lymph circulation. Your health care provider may suggest other approaches (including different exercises,a low-salt diet, or a machine that increases the circulation in your arm).
If lymphedema becomes a long-term problem, your health care provider may suggest additional physical therapy.
Caption:
This is a machine that compresses your arm to help the lymph fluid flow.
Many surgeons today (in 1995) use lymph node dissection to help them estimate how long you will live, and to choose the best systemic treatment. Positive lymph nodes mean that a stronger systemic treatment may be recommended.
Regular exercise should become a part of your normal activities. If you decide to have a mastectomy and immediate breast reconstruction, you might need different physical therapy, which your health care provider will explain.
It is almost always done for invasive breast cancer.
How long does the operation take?
The operation takes about 2 hours. It is a hospital procedure done with a general anesthetic. You will wake up in the recovery room and depending on how your body reacts to the anesthesia and surgery, you will probably need to stay in the hospital for a day or two.
Can this be done at the same time as a lumpectomy or a mastectomy?
An axillary node dissection is often done with a mastectomy. It is sometimes done with a lumpectomy, if a clear diagnosis of cancer has already been established. Otherwise it is done as a second procedure, after a pathological analysis of the tissue removed during your lumpectomy.
Does the procedure hurt?
There is some post-operative pain, and pain medication can be prescribed for you. You will need to stretch the tissue under your arm as you work to regain a full range of motion. This may cause some minor discomfort but it is very important to do these exercises. Pain medication will be provided to you for this purpose if necessary.
How many nodes are removed?
Usually between 10 and 20 lymph nodes are removed. Because the nodes are embedded in fat, the surgeon wonÕt know how many lymph nodes are actually removed until the pathologist examines them. There is also individual variation in the number of nodes imbedded in the removed fat. The number of nodes is not as important as where they are taken from. Every womenÕs nodes are taken from the same "geographic" area in her underarm.
What will I look like after the operation?
Directly after the operation there is usually a small tube in place under your arm (held by a few stitches). The end of the tube has a bulb (about the size of a blood-pressure bulb) which holds the fluid that drains from the surgical area for several days after the operation. It is usually emptied by you or a family member several times a day. When there is consistently less than a tablespoon accumulated, the tube can be easily removed in the doctor's office. There is an thin incision under your arm after the surgery, and perhaps an indentation where the fat has been removed.
A more unusual temporary complication within a week after surgery is a large build-up of fluid under your arm. It is common to have some swelling, but occasionally some women may feel a orange-sized lump under their arm. This is called a seroma. It is a fluid-filled area. If this occurs your surgeon can drain off the fluid.
Will my arm be more susceptible to infection?
Your arm and hand are more susceptible to infection since many of the lymph nodes that protect against infection have been removed. It is important to protect that arm and hand forever. You should make sure that blood pressure or blood drawing is always done in your other arm if possible. You should wear gloves when doing any work that could potentially injure your hand, such as dish washing, gardening, or some sports. Most women are asked to check their arm and hand regularly to insure there are no cuts or inflammation. If the tissue has even a minor injury, antibiotics are usually recommended.
Is there a risk of long term complication?
Yes, you may have temporary or permanent numbness under your arm, and you will always have a higher risk of infection in that arm. There is a 3% chance you may develop lymphedema, a serious side effect that results from excess fluid in your arm.
Will the range of motion in my arm be affected?
Right after the surgery your shoulder will feel sore and somewhat stiff. It may be difficult to move it in all directions. However, soon after surgery you will be given a series of arm movement exercises to do daily. This helps limber up your arm and shoulder movement. Eventually most women gain 100% motion in the affected arm. It is important to do these exercises daily for many months after the surgery, to establish and maintain full range of motion. In some cases, exercises are recommended for the rest of your life.
How long does it take to recover from this surgery?
This depends on each woman's individual circumstances, ask your health care provider about your specific case.
They take the lymph nodes out to find out how far your cancer is. If the lymph nodes is full of cancer, everyone they took out has cancer, that means your pretty late stage and then they give you a different dosage of chemotherapy. Mine was zero. I was lucky. The took seventeen out, none of them had cancer, so it didn't spread to the lymph nodes. So that's good news.
The first mastectomy they took 27 lymph nodes out of my left arm, and that made the recovery much more difficult. On the right side, they never took any lymph nodes and the recovery was much faster. I think I went six times to a physical therapist and we did all these exercises. There are marks on my bedroom wall. At first I could reach this high, and then I could reach this high, and then I could reach this high, and I never thought I would ever be able to do any of these things again.
One side effect of radiation or lymph node surgery is a condition called lymphedema. This involves swelling of the arm and the hand. Your arm is not draining and there's an accumulation of fluid. It was recommended that I be fitted for an elastic sleeve that hopefully would keep enough pressure on my arm to see that the lymph fluid was draining. That was not successful. Right now I'm using what they call a lymphapress. It almost looks like an air cast for your arm. It's hooked to a motor and it pushes the lymph fluid up your arm and into your back. I'm probably not as diligent as I ought to be in using it, but some women are sleeping with these on their arm every night. Some women are using them two hours day. Some women need to use them once every three or four days.
I went in for the lymph node, under the arm business. That was an overnight at the hospital, which again, is not a bad, you can't complain about going in the hospital at 10:00 in the morning and coming home the next day at 10:00 in the morning. I guess I wasn't a prepared for the long-term adjustment to the arm problems. I had a lot of mobility in my arm from the beginning. She's a very good surgeon. So the exercises that they gave me at the hospital to be sure I did have, were just easy. It wasn't anything at all. But I can tell you even now, I know that it's happened.
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If tests show that cancer cells have spread to your axillary lymph nodes, there is a greater chance that cancer has also spread to other parts of your body. This is called metastasis. Finding ÒpositiveÓ lymph nodes (nodes that contain cancer cells) means that you may need more aggressive treatment than if your nodes were negative.up to Contents of this Page
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In most cases an axillary node dissection is a not a treatment that affects overall survival. It is done to aid your diagnosis. Some women may feel that the potential side effects from this surgery may outweigh the benefits. You should discuss your concerns with your health care providers, and may wish to seek a second opinion.up to Contents of this Page
In most cases, exercising after surgery can help you regain motion and strength in your arm and shoulder. It can also reduce pain and stiffness in your neck and back. You should start planned exercises as a soon as you and your health care provider think you are ready, sometimes within a day or so after surgery. This happens while you are still in the recovery period. Gradually, you will move to more active exercises.up to Contents of this Page
How often is this surgery done?up to Contents of this Page
Lily's experience
Sheila's experience
Linda's experience
Nancy's experience
