Axillary Lymph Node Dissection

Your axillary lymph nodes act like a checkpoint for lymph draining from your arms, breasts and chest wall. Lymph is a watery, colorless fluid that, among other things, sweeps up cancer cells.

You have between 20 and 40 axillary lymph nodes located in several groups within each of your armpits. When you have breast cancer, your armpit (axillary) lymph nodes are generally the first place that cancer spreads (metastasizes).

What is axillary lymph node dissection?

Axillary lymph node dissection (ALND) is surgery to remove the lymph nodes in your armpit. Surgical oncologists do this surgery to see if cancer from your breast is in these nodes.

You may have this procedure as part of breast cancer surgery, like a lumpectomy or mastectomy. But in some situations, your oncologist will do ALND after surgery.

Your surgical oncologist may recommend you have this procedure as part of your breast cancer surgery if:

• Your provider can feel swollen lymph nodes in your underarm or collarbone area, as cancer in lymph nodes can make them swell
• Imaging tests show signs of swollen axillary lymph nodes — imaging tests may include a breast ultrasound, computed tomography (CT) scan or positron emission tomography (PET) scan
• A sentinel node biopsy shows that three or more of your lymph nodes contain cancer cells (this test involves removing the first few nodes in a group of lymph nodes where a particular cancer is most likely to spread)
• A course of presurgical chemotherapy to shrink a breast cancer tumor doesn’t eliminate cancer in target axillary lymph nodes

What happens before axillary lymph node dissection?

Your surgical oncologist will explain specific steps you should take before surgery, like whether you should stop eating and drinking (fasting). You’ll typically receive general anesthesia so you’re asleep during surgery.

What happens in axillary lymph node dissection?

To perform an axillary lymph node dissection, your surgical oncologist will:

1. Make an incision (cut) in your armpit so they can get to the lymph nodes that tests show may contain cancer cells
2. Remove the tissue containing the lymph nodes from a particular area in your armpit
3. Place a surgical drain in the surgery site
4. Close the incision
5. Send the tissue to a medical pathologist to examine

What are the benefits of axillary lymph node dissection?

This procedure is how your surgical oncologist finds out if there’s cancer in your axillary lymph nodes. If you have cancer in these lymph nodes, it can spread to other areas of your body.

What are the risks of axillary lymph node dissection?

Axillary lymph node dissection may affect your lymphatic system so it doesn’t move lymph through your body like it should. That can cause lymphedema (swelling in your arm). That swelling can lead to skin issues, like wounds and infections. Other potential axillary dissection complications include:

• Axillary web syndrome (AWS), which is scar tissue in your lymph vessels that causes pain and may make it hard for you to move your shoulder
• Bleeding
• Infection
• Nerve damage

Your surgical oncologist may refer you to a lymphedema specialist as part of your treatment team to watch for signs or symptoms of lymphedema. These specialists can recommend ways to prevent it.

What do the results of an axillary lymph node dissection mean?

In general, a high number of cancerous axillary lymph nodes leads to a higher overall cancer stage. Node categories are:

• N1: A sentinel node biopsy shows there’s cancer in one to three axillary lymph nodes. Or there are abnormal internal lymph nodes in your chest.
• N2: An axillary lymph node dissection detects cancer in four to nine underarm lymph nodes. Or there are abnormal internal lymph nodes in your chest.
• N3: Cancer affects 10 or more axillary lymph nodes. Or cancer is spreading to lymph nodes under your collarbone.

But it’s important to remember the lymph node number is just one factor in staging breast cancer. Your surgical oncologist will also consider:

• Tumor size and location
• Whether the tumor is spreading (metastasizing) to nearby tissues
• The tumor receptor status, like whether the tumor contains the estrogen receptor protein or the progesterone receptor protein

It’s not always easy to make sense of cancer staging. Don’t hesitate to ask your surgical oncologist to explain how the results may affect your situation.

When should I call my oncologist?

Call your oncologist if you experience:

• Redness or discharge at the surgery site: This may be a sign of infection.
• More pain than you expected: Or your prescription pain medication doesn’t reduce your pain.
• Swelling in your arms and hands: This may be a symptom of lymphedema.