Breast cancer can spread to other parts of the body. It first spreads to the lymph nodes in the armpit (axilla) close to the breast. Lymph nodes are lumps of special tissue that drain the fluid from the breast and arm. The first nodes in the axilla affected by breast cancer are known as sentinel or guardian lymph nodes. If cancer spreads to sentinel lymph nodes or adjacent nodes in the axillary area, they need to be removed.
If cancer affects three or more sentinel lymph nodes, the physician may recommend axillary dissection (removal). There are three levels of axillary lymph nodes, which are also options for removal:
- Level I: This refers to the removal of all tissue below the axillary vein and extending to the side where the axillary vein crosses the back muscle called the latissimus dorsi.
- Level II: This includes the removal of lymph nodes present under the chest wall muscles called the pectoralis minor.
- Level III: This includes complete removal of nodes present above the pectoralis minor muscle.
What is the axillary dissection of the lymph node?
Axillary dissection is a surgical procedure that involves the opening of the axilla to identify, examine, or remove the lymph nodes.
It has been the standard technique used for the treatment of breast cancer affecting the axilla.
When is axillary dissection indicated?
Axillary dissection is indicated in patients with a proven axillary disease. It is indicated:
- If the previous sentinel node biopsy has revealed that three or more lymph nodes are affected by cancer cells
- If the surgeon can feel swollen underarm or collarbone lymph nodes before the surgery or during any diagnostic tests
- If cancer has spread to the outside of the lymph nodes
- If sentinel node biopsy shows positive for cancer cells postchemotherapy sessions to shrink the tumor cells.
There is no special caution for this surgery. The only requirements are patients who can tolerate the procedure and are appropriate for anesthesia.
How to prepare for axillary dissection?
The physician recommends a full range of shoulder exercises before the surgery. You need to avoid heavy lifting with the arm affected by cancer to prevent the risk of swelling in one of your arms or legs.
How is axillary dissection performed?
The axillary dissection is performed simultaneously during a mastectomy surgery and is usually carried out under general anesthesia. The surgeon makes an incision under the arm and removes 10-40 lymph nodes from level I and II. The surgeon usually doesn’t remove level III axial lymph nodes because it affects the survival rate of the patient. However, the formation of lumps or bigger nodes may force the surgeon to remove the level III lymph nodes. Finally, the surgeon places a small tube and closes the incision with stitches or staples. A drainage bag attached to the end of the tube helps in the collection of fluid and prevention of fluid buildup.
Following the surgery, the patients may be given:
- Antibiotics to prevent infection
- Pain relievers
- Information about shoulder range exercises
- Instructions about the caring and dressing of the wound
- Instructions about the type and range of activities to be performed
- Information about complications and side effects of the surgery, which includes:
- Signs of infection, such as pain, redness, or pus
- Discomfort and soreness around the wound site
- Hematoma (pooling of blood)
- Swelling and bruising over the breast or axilla
- Seroma (fluid accumulation under the skin in the armpit)
- Shoulder stiffness
- Lymphedema (swelling of one of the arms or legs)
- Numb patch on the upper arm
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