Axillary Lymph Node Dissection
The axillary lymph nodes are located under the arm. Axillary node dissection is performed to determine if cancer has spread beyond the breast. Cancer cells found in the lymph nodes suggest that it may have spread to other parts of the body and the patient may need more aggressive treatment. The results of this test help the patient and physician plan the best course of therapy.
An axillary node dissection may be done at the same time as a lumpectomy or a mastectomy. It may be scheduled following a positive biopsy.
Axillary node dissection is performed under general anesthesia (agent that renders the patient unconscious) at a hospital. The surgeon makes an incision under the arm and removes a pad of fat in which 10 to 20 lymph nodes are embedded. The incision is sutured and a drain may be put in to remove excess fluid. The procedure takes between 1 and 2 hours.
A few days before surgery, tests are usually performed to assess the patient's health. Preoperative tests ordered vary according to the patient's age and health, but generally include a blood test, a chest x-ray, and possibly an electrocardiogram (EKG). If these tests have been performed recently, such as for breast biopsy, they do not need to be repeated.
If the patient is taking medication that "thins" the blood, including aspirin, they should speak to their physician about it as soon as the decision to do the biopsy has been made. Patients usually stop taking blood thinners several days prior to a scheduled operation to avoid excessive bleeding during the procedure.
Because axillary dissections are usually performed under general anesthesia, the patient must refrain from eating or drinking at least 8 hours prior to surgery. This may include oral medications, and this must be discussed with the physician. On admission to the hospital, the patient must sign an informed consent form acknowledging that they understand the procedure and its risks, and that they will be receiving anesthesia and certain medications.
The anesthesiologist (the doctor who administers the anesthesia) performs a brief physical examination and takes the patient's medical history. The anesthesiologist asks about medications that are currently being taken, about a history of allergies, and about previous adverse reactions to anesthesia. This information is essential to assess possible conditions or problems that may influence the choice of anesthesia and to take any special precautions if necessary.
An intravenous line (IV) will be started to administer fluids and medication during the procedure. This may be done in the patient's room or in the preoperative holding area. It is necessary to stay in bed from this point on, except to use the bathroom.
Sedation may be given in the holding area or in the hospital room, and the anesthesia is administered in the operating room.
Immediately following surgery, the patient is taken to the postanesthesia care unit (PACU) and is closely monitored by the nursing staff until the anesthesia wears off. When the patient fully awakens from the anesthesia and the vital signs are stable, she is transferred to her room.
The IV remains in until clear liquids taken orally are tolerated. Most patients are able to eat and drink soon after they wake up from anesthesia. Unless an intravenous medication (e.g., antibiotic) has been ordered, the IV is removed at this time.
Once the anesthesia wears off, pain is felt in and around the incision site and pain medication is prescribed. There may be a tube draining fluid, which usually stays in until the first postoperative doctor's appointment. Most patients remain in the hospital overnight and the stay may be extended if complications develop.
The incision under the arm fades over time. Patients may notice an indentation in their armpit where the fat was removed, sore muscles, tightness in the arm, and difficulty moving the arm. Stretching and range of motion exercises help and should be started as soon as permitted. A physical therapist or other practitioner can set up an exercise program to increase arm movement.
The drain and stitches are removed during the first follow-up visit. The area must be kept dry and sponge baths may be recommended. Deodorant should not be applied to the incision until healing is well underway.
The recovery period lasts about 6 weeks and heavy lifting and strenuous activity should be avoided. Some patients experience a loss of sensation under the arm caused by nerves being cut during the procedure. This loss of sensation may be permanent. It may take longer for the affected arm to regain its strength and full range of motion.
The most common complications are:
- Permanent numbness under the arm
- Lymphedema (swelling of the arm caused by scarring the lymph vessels) occurs in fewer that 12% of cases
- Infection of incision site
An increase in pain, drainage, redness, or swelling at the site of the incision may indicate infection and should be reported to the physician immediately.
An axillary dissection removes many of the lymph nodes that protect against infection, and the hand and arm on the affected side may become more susceptible. Blood should not be drawn from this arm, and minor injuries should be reported to the physician. The hand and arm should be checked regularly for inflammation or cuts.