Axillary Lymph Node Dissection

Lymph is a body fluid that contains white blood cells and proteins. It travels through the body in lymphatic channels (like blood vessels) and brings the lymph through lymph nodes. The nodes filter out bacteria, cancer cells, and waste materials from the lymph so they do not get into the bloodstream. A lot of the lymph from the tissues and skin in the arm and chest drain into the lymph nodes in the axilla (armpit area).

The axillary lymph nodes may be removed if the cancer has already spread to the nodes or they may be removed in order to examine them under a microscope to see if the cancer has spread from the original tumor site as part of the diagnosis and staging process.

Cancer cells found in the lymph nodes suggest that it may have spread to other parts of the body and the patient may need more aggressive treatment. The results of this test help you and your physician plan the best course of therapy.

What Happens During Surgery?

• Axillary node dissection is performed under general anesthesia.
• The surgeon makes an incision under the arm and removes a pad of fat in which an average of 10 to 20 lymph nodes are embedded.
• The incision is sutured and a drain may be put in to remove excess fluid.
• The procedure takes between 1 and 2 hours.

Your Recovery: Caring for Yourself at Home

• Your doctor will determine when you are able to go home.
• You will receive written instructions (discharge instructions) from your nurse before you go home.
• Please feel free to ask your doctor, resident, fellow, or nurse for help or information.
• A prescription for pain medicine will be given to you when you leave.
• The day and time of your first follow-up visit may be set at this time or you will be given instructions when to call to schedule your appointment.

Caring for Yourself at Home

Each day following your surgery, you will feel better. Here is a guide to some general instructions for you to follow to aid in your recovery.

• The incision under the arm fades over time. You may notice an indentation in your armpit where the fat was removed, sore muscles, tightness in the arm, and difficulty moving the arm.
• Stretching and range of motion exercises help and should be started as soon as permitted. A physical therapist can set up an exercise program to increase your arm’s range of motion.
• The drain and stitches may be removed during your first follow-up visit. The area must be kept clean and dry and sponge baths may be recommended.
• Deodorant should not be applied to the incision until healing is well complete.
• You may feel either numbness or tingling (pins and needles) in your armpit or on the inside of your upper arm. This is due to damage to the local tissues, nerves, and superficial nerves that occurred during the operation. This will gradually improve over the next several weeks. Sometimes, small areas of numbness may remain.
• Your incision will be covered with a dressing to help the wound heal and prevent infection.
• Your nurse will instruct you on when to schedule your first post-op visit.

Activity

• Do not raise your elbow above shoulder level on the affected side until your drain is removed
• Do exercises given to you to help regain mobility and prevent swelling (lymphedema)
• Continue posture, mobility, and strengthening exercises until you have no difficulty moving your arm in all directions
• Do not lift more then 10 pounds with your affected arm for 4 weeks
• Do not drive until after your drain is removed or until advised by your surgeon
• Do not drive if you are taking narcotic pain medication
• Do not lift anything heavier than 5 lbs (six pack of soda)
• When sitting, prop your arm on a pillow to prevent swelling
• If your drain has been removed and you have no dressing on your incision, clean it daily with soap and water

Call Your Doctor Right Away If:

Be sure to check your incision site daily. Call your physician or nurse immediately if you have:

• swelling
• increased redness or heat near the area of surgery
• increased drainage containing pus (green or yellow discharge)
• bad odor from the wound or drains
• increased pain or tenderness
• temperature of 101° F (38°C) or higher
• bleeding from the incision that is difficult to control with direct pressure
• you notice that there is leakage around your drainage tube and the gauze dressing is soaked (larger then a 1 inch area)
• you are vomiting for longer than 24 hours
• you have diarrhea (loose stools 3x a day) lasting more than 24 hours

To report symptoms, call the Sarcoma/Melanoma Center, Monday to Friday 8:00 am - 4:30 pm at (716) 845-3180.

After hours, weekends, and holidays, please call (716) 845-2300 or 1-800-685-6825 and ask for the Sarcoma/Melanoma surgeon on call.