Axillary node dissection

The most accurate way of predicting spread of the cancer is by looking for cancer cells in the draining lymph nodes.

Lymph node dissection is performed through a cut under your arm. The fatty tissue containing the small lymph nodes is removed and sent to the laboratory for analysis. There are approximately 20-30 nodes under your arm and this operation usually removes 10- 15 of the lower nodes. This is sufficient to stage the cancer accurately and leaves some nodes and their drainage channels.

Possible complications:

1. Nerve damage- There are three nerves in this area that may be damaged during surgery.
The intercostobrachial nerve is a tiny sensory nerve that supplies feeling to the skin on the inside of your arm.  If it is divided you may be left with some numbness under your arm. This will not affect the strength or function of the arm.
The two other nerves are larger structures that are usually easily seen and preserved. There is a 1% chance of them being damaged. They supply muscles around the shoulder and if damaged can result in weakness or altered function in the arm.

Fluid can accumulate under the arm after surgery causing swelling and discomfort. A small plastic drain will usually be placed through the skin at the end of your operation to drain this fluid. Once the drain is removed the fluid may build up and can be drained very simply in the clinic under local anaesthetic using a needle and syringe. The fluid build-up usually stops within 2 -3 weeks.

2. Stiff shoulder - Exercising the arm under the supervision of a phyiotherapist will speed recovery and reduce the risk of stiffness.

3. Stringing - You may feel a tight cord of tissue running down the inside of your arm. This is caused by congested lymphatic vessels. It usually improves with physiotherapy and time.

4. Lymphoedema - If your breast surgery involves axillary node dissection there is a possibility that you could develop some swelling of the arm on that side. This is called lymphoedema and may occur soon after the operation or many months later. The risk of clinically significant swelling is 5 - 10%. If swelling occurs it may be not be easy to treat may become progressively worse.
Lymphoedema is due to a backlog of lymphatic fluid in the arm as a result of damage to some of the small lymphatic channels in the axilla. If radiotherapy is given to the axilla then the risk of swelling is increased.

Lymphoedema can be difficult to treat and prevention is better than cure. There are some simple measures that you can take to reduce risk. We want you to avoid situations that could either damage remaining lymphatics or that increase lymphatic flow.

• Protect the arm from sunburn
• Use gloves when gardening.
• Use an electric razor when shaving under your arm to avoid abrasions.
• Avoid blood sampling and injections in the treated arm if practical.
• Avoid prolonged, repetitive actions with the arm.

Use these guidelines to make sensible everyday decisions. They are not meant to be excessively restrictive. Remember that one of the aims of treatment is to get you back to your normal activities as far as possible!

If you have any queries discuss them with your physiotherapist or general practitioner.