Axillary Lymph Node Dissection

If breast cancer spreads, the first tissues to be affected are usually the lymph nodes in the underarm area (axillary lymph nodes), which filter lymph drainage from the breast. As part of the breast cancer staging process, one or more axillary lymph nodes may be removed so they can be examined in a lab for signs of cancer. One type of lymph node surgery is an axillary lymph node dissection, which involves removing most or all of the axillary lymph nodes. Another type is a sentinel lymph node biopsy, which involves removing only the lymph nodes that are closest to the tumor (sentinel nodes).

The latest breakthroughs in breast cancer services—including axillary lymph node dissection and other advanced diagnostic procedures—are available through Tampa General Hospital’s Cancer Institute and renowned Breast Cancer Center, which is accredited by the Commission on Cancer (CoC). Firmly positioned among the top 10% of hospitals in the nation, TGH has earned the “High Performing in Cancer” designation from U.S. News & World Report for 2022-23.

When Is an Axillary Lymph Node Dissection Considered?

An axillary lymph node dissection may be considered if:

  • A positive sentinel lymph node biopsy revealed cancerous cells in three or more lymph nodes.
  • Swollen or enlarged lymph nodes can be felt around the armpit or collarbone or can be seen in diagnostic images.
  • A fine needle aspiration or core needle biopsy revealed cancerous cells in an axillary lymph node.

What Does an Axillary Lymph Node Dissection Involve?

An axillary lymph node dissection may be performed during breast cancer surgery, such as a lumpectomy or mastectomy, or as a standalone procedure. In general, it involves the following steps:

  • The surgeon makes an approximately two-inch incision in the armpit.
  • The surgeon removes the pad of fat from the hollow of the armpit, which contains most or all of the axillary lymph nodes (usually between 20 and 30).
  • The removed tissues are sent to a lab, where a pathologist isolates the lymph nodes.
  • The pathologist cuts each lymph node in half, places each specimen on a slide and examines the slides under a microscope for evidence of cancer.

What to Expect With an Axillary Lymph Node Dissection

After an axillary lymph node dissection, some patients experience pain and numbness around their surgical site as well as stiffness and reduced range of motion in their shoulder. A physician can suggest targeted arm and shoulder exercises to help resolve these symptoms and prevent frozen shoulder, a complication that can develop due to extended immobility.

Some patients also notice lymphatic cording, a rope-like structure that develops under the arm and extends to the elbow. Although lymphatic cording can be painful, the condition usually resolves on its own. In the meantime, physical therapy can improve comfort if necessary.

When axillary lymph nodes are removed, the lymph they previously drained may begin to collect in the underarm area, causing a long-term condition known as lymphedema. In addition to discomfort, lymphedema can lead to potentially serious infections if left untreated. Therefore, after an axillary lymph node dissection, it is important to watch for signs of lymphedema, which can include:

  • Swelling in the armpit, breast, chest, shoulder or arm
  • Skin warmth, redness, tightness or hardness
  • Sensations of numbness, aching, tingling, fullness or heaviness
  • Reduced range of motion in the shoulder
  • Difficulty fitting the arm into the sleeve of a shirt or jacket

Lymphedema treatment typically includes a combination of physical therapy and compression garments or multilayer compression bandaging to help move the lymphatic fluid away from the affected areas. It can also be helpful to keep the affected arm elevated as much as possible.

How Effective Is an Axillary Lymph Node Dissection?

According to recent research studies, the breast cancer recurrence rate is less than 5% after an axillary lymph node dissection. As such, the procedure can effectively control locally advanced breast cancer and usually eliminates the need for follow-up radiation therapy.

Benefit From World-Class Care at TGH

TGH offers comprehensive and compassionate care for patients with breast cancer. If would like to talk with an expert on our team, contact us at (800) 844-4554 to request an appointment.