Axillary node dissection
Axillary node dissection is the removal of the lymph nodes under the arm on the same side as your cancer. It is done to determine whether cancer has spread to those lymph nodes and to determine the stage of your breast cancer.
When is an axillary dissection done?
This procedure is usually done in three situations when you are diagnosed with breast cancer.
- Your doctor may feel lymph nodes on examination of your arm pit area. If those enlarged lymph nodes are biopsied with a needle and show cancer, then an axillary dissection will be recommended.
- Your doctor also may sonogram the arm pit area. If nodes that look suspicious are found, then a needle biopsy is performed. If the needle biopsy shows cancer, then an axillary node dissection will be recommended.
- If no nodes are felt or seen on testing, then a sentinel node biopsy will be done at the time of your surgery. A sentinel node biopsy is a procedure where just a few lymph nodes are removed. If these sampled lymph nodes show cancer, then a full node dissection will be performed.
Why is an axillary dissection performed?
This surgery is a diagnostic tool that determines the stage of your cancer. It will help your medical oncologist (cancer doctor) determine if you require chemotherapy and/or radiation therapy after your surgery. It is not done to improve the chance of cure from breast cancer, but in some situations may keep large cancerous nodes from growing and causing problems. Radiation can help control the nodes as well and that is why radiation is recommended when you have many (four or greater) nodes that contain cancer.
How is an axillary dissection done?
A clump of fatty tissue is removed from under your arm. It may be removed by using the same mastectomy incision, or a separate incision may be required if you have a lumpectomy or skin sparing mastectomy. That incision will be located just below where your arm-pit hair stops growing. Everyone’s anatomy is different, but usually 10 to 30 nodes are removed. Each lymph node is checked for cancer.
What are the risks of the procedure?
The most concerning side effect of axillary node dissection is lymphedema which is a severe swelling of the arm. If the arm has lymphedema, it is more prone to infection. There is also a possibility of developing a seroma, a pocket of lymph fluid that collects in the arm pit. This is the reason a drain must be placed at the time of surgery. There is a risk of bleeding and infection. There is also a risk of injury to sensory nerves that may cause numbness, pain or tingling. There are two motor nerves that may be injured which can cause problems with shoulder motion. After surgery the shoulder may be stiff from the scar and exercises will be recommended to help improved mobility.