Axillary Lymph Node Dissection

Axillary lymph node dissection is a diagnostic procedure used to see if the cancer that started in the breast has spread to the lymph nodes underneath the arm. During the procedure, 10-15 of the lymph nodes that drain from the breast are removed. A pathologist then determines if any of the lymph nodes could contain cancer.¹

Women who have lymph nodes removed as part of breast cancer surgery may be at an increased risk for developing lymphedema, a condition caused by blockages of the lymph vessels. Lymph vessels run throughout the body carrying fluid, cells, and other material, but may become blocked when lymph nodes are removed. This will result in swelling of the arm.

To reduce the risk of developing lymphedema, the following precautions are recommended:

• Treat infections of the affected arm and hand immediately.
• Maintain a healthy weight. The greatest risk factor for the development of lymphedema is obesity.
• Wear gloves when doing house or garden work.
• Keep the affected hand well moisturized.
• Use the unaffected arm when having blood drawn or getting injections.
• For 4-6 weeks after surgery, use the unaffected arm when lifting heavy objects.
• Protect the arm from sunburn.
• Do not cut cuticles.
• Use insect repellant when outdoors.
• Keep skin clean.

Because of the possible side effects from a standard axillary lymph node dissection, patients may qualify to have a special procedure performed that may not require that many lymph nodes be removed; this has been shown to reduce the chances of swelling, pain, and lymphedema. This is called Sentinal Lymph Node Biopsy.

In brief, a radioactive tracer and blue dye is injected around the tumor in the breast, and the tracer is followed into the armpit. The lymph nodes that pick up the tracer are called the sentinel lymph nodes. The lymph nodes are removed and evaluated.

If there is no cancer, then there is a 95% chance that none of the other axillary lymph nodes have cancer and no further surgery to the armpit is required. If the lymph node has cancer, then a complete axillary dissection is performed.

There is some debate about whether a completion axillary dissection must be performed after a sentinel node procedure has shown rare cancer cells in the armpit. Several scientific groups are evaluating this very question, and you may be a candidate to enroll in a study. Ask your surgeon for more information. If your surgeon does not perform the sentinel lymph node procedure, you can talk with another doctor who has experience with this type of surgery.

1. Kathleen M Diehl, MD and Alfred E. Chang, MD Division of Surgical Oncology, University of Michigan Comprehensive Cancer Center. Sentinel Lymph Node Biopsy: What Breast Cancer Patients Need to Know Retrieved on November 15, 2010 from: http://www.cancernews.com/data/Article/202.asp

Breast cancer. National Cancer Institute website. Available at: http://www.cancer.gov . Accessed January 27, 2006.

Breast cancer. Womens' Health.gov website. Available at: http://www.4woman.gov . Accessed January 27, 2006.

Susan G. Komen Breast Cancer Foundation website. Available at: http://www.komen.org . Accessed January 31, 2006.

Way LW, Doherty GM. Current Surgical Diagnosis and Treatment . 10th ed. Appleton and Lange; 1994.