Axillary Lymph Node Dissection

What is Axillary Lymph Node Dissection

Axillary lymph node dissection is a procedure to remove (dissect) lymph nodes that are located around the armpit (axilla). Lymph nodes are collections of tissue that filter bacteria, viruses, and waste from the bloodstream.

They are part of the body’s disease-fighting system (immune system). The axillary lymph nodes drain fluid (lymph) from the breast and surrounding areas.

Lymph nodes will be removed from the area around the muscle that is between the breast and shoulder (pectoralis minor muscle). Lymph nodes below the lower edge of the muscle (level Ilymph nodes) and underneath the muscle (level II) are usually removed. If cancer has spread to the level II lymph nodes, some lymph nodes above the muscle (level III)may also be removed.

This surgery may be done to check whether cancer has spread (staging). The procedure may be done at the same time as a procedure to remove a breast tumor (lumpectomy) or a procedure to remove breast tissue (mastectomy).

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs.
  • Pain.
  • Numbness in the arm.
  • Swelling in the arm (lymphedema).
  • Blood clots.

What happens before the procedure?

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do not take these medicines unless your health care provider tells you to take them.
  • You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • You will be placed on your back. Your arm will be straight out from the side of your body, resting on a support.
  • An incision will be made on the side of your armpit, next to your breast.
  • Tissue and muscle will be moved out of the way to allow access to the lymph nodes.
  • Level I and level II axillary lymph nodes will be removed. This total may be 10–40 lymph nodes. If necessary, level III lymph nodes will also be removed.
  • A drainage tube may be placed in the side of your breast to help drain fluid from the surgical area.
  • Your incision will be closed with stitches (sutures) and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • Do notdrive for 24 hours if you were given a sedative.
  • You might be asked to wear a compression garment on your arm. This garment helps to prevent blood clots and reduce swelling in your arm.
  • If you have a drainage tube, it may be left in place for up to 7–10 days.
  • It is up to you to get the results of your procedure. Ask your health care provider, or the department that is doing the procedure, when your results will be ready.

Summary

  • An axillary lymph node is a lymph node that is located around the armpit (axilla).
  • An axillary lymph node dissection is surgery to remove many of the axillary lymph nodes.
  • During this procedure, lymph nodes are removed from the area around the muscle that is between your breast and shoulder (pectoralis minor muscle).
  • After the procedure, you may need to wear a compression garment on your arm to prevent blood clots and reduce swelling.
  • You may have a drainage tube placed in your breast during the surgery. It may be left in for 7–10 days.

Axillary Lymph Node Dissection, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain and soreness around your incision area.
  • Trouble moving your arm or shoulder.
  • A small amount of swelling in your arm.
  • Numbness on the upper and inside parts of your arm.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider.Do notstop taking the antibiotic even if you start to feel better.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Check for:

  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

  • Do arm and shoulder exercises as told by your health care provider. This may prevent movement problems and stiffness.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you. Avoid any activities that cause pain.

Driving

  • Do notdrive for 24 hours if you were given a medicine to help you relax (sedative).
  • Do notdrive or use heavy machinery while taking prescription pain medicine.

General instructions

  • If a drainage tube was left in your breast, care for it as told by your health care provider. The drain may stay in place for up to 7–10 days.
  • Wear a compression garment on your arm as told by your health care provider. This may help to prevent blood clots and reduce swelling in your arm.
  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths for bathing.
  • Do not have your blood pressure taken, have blood drawn, or get injections or IVs in the arm on the side where your lymph nodes were removed.
  • Follow instructions from your health care provider about how often you should be screened for extra fluid around your lymph nodes (lymphedema).
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your arm is swollen, tight, and painful.
  • You have redness, swelling, or pain around your incision.
  • You have fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.

Get help right away if:

  • You have severe pain that does not get better with medicine.
  • You have a fever or chills.
  • You are confused.
  • You have chest pain.
  • You have shortness of breath.

Summary

  • After the procedure, it is common to have pain and soreness and trouble moving your arm or shoulder.
  • A small amount of arm swelling is normal after the procedure. However, you should contact your health care provider if your arm is swollen, tight, and painful.
  • Wear a compression garment on your arm as told by your health care provider. This may help to prevent blood clots and reduce swelling in your arm.
  • Do arm and shoulder exercises as directed to help prevent movement problems and stiffness.
  • If a drainage tube was left in your breast, care for it as told by your health care provider.
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