What is axillary lymph node dissection?

An axillary lymph node dissection, also known as axillary node dissection or axillary lymphadenectomy, is a cancer treatment surgery used to remove lymph nodes in the armpit.

Levels of axillary lymph nodes include:

  • Level I — nodes located below the lower edge of the pectoralis minor muscle
  • Level II — axillary lymph nodes located underneath the pectoralis minor muscle
  • Level III — nodes are located above the pectoralis minor muscle

Women who have invasive breast cancer typically have an axillary lymph node dissection at the same time as a mastectomy. If you are having a lumpectomy, your doctor may take the lymph nodes during that procedure or during a later procedure.

Why is axillary lymph node dissection performed?

Your Mercy Health cancer care doctor may recommend an axillary lymph node dissection to:

  • Determine if you have cancer in the lymph nodes in the armpit and if so how many lymph nodes are affected
  • Remove cancerous lymph nodes or cancer within the lymph nodes after other cancer treatments such as radiation therapy or chemotherapy
  • Lessen the probability that the cancer will recur
  • Take out lymph nodes in patients who have aggressive cancer that is likely to spread to them

What to expect during axillary lymph node dissection?

Axillary lymph node dissection is performed in a Mercy Health operating room under general anesthesia. The procedure typically takes an hour. In some cases, your doctor may remove the lymph nodes while removing cancerous breast tissue.

Your doctor typically removes levels I and II lymph nodes, but not level III lymph nodes. Survival is not increased when level III nodes are removed.

Your doctor will evaluate your total number of lymph nodes that indicate the presence of cancer rather than the extent of cancer in a specific lymph node.

For level I or level II lymph nodes, your doctor will cut a two- to three-inch incision to remove 10 - 40 lymph nodes from under your arm. If you have level III lymph nodes, your doctor will remove lymph nodes if there is a cancerous lump or tumor in the armpit.

After the lymph nodes have been removed, your doctor will drain the area, close the incision and attach a drain bag to the area. The drain bag may be needed to collect draining fluid for a few weeks. 

The nodes are sent to a Mercy Health pathologist to determine if the cancer has moved to the lymph nodes. It will take a few days for the pathology report to be finished.

You will typically be discharged from the hospital one to two days after the procedure.

Risks associated with axillary lymph node dissection

Risks associated with axillary lymph node dissection include:

  • Severed nerves during surgery, which results in the loss of feeling on the back of the arm or armpit
  • Discomfort in the back of the arm
  • Limited range of motion in the arm
  • Vein inflammation in the arms as they pass through the armpit
  • Damage to the shoulder blade if the nerves in the shoulder blade are cut during the procedure
  • Infection in the surgical area

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