Lymph Node Surgery
The most accurate way of predicting spread of the cancer is by
looking for cancer cells in the draining lymph nodes.
Lymph node dissection is performed through a cut under your arm.
The fatty tissue containing the small lymph nodes is removed and
sent to the laboratory for analysis. There are approximately 20-30
nodes under your arm and this operation usually removes 10- 15 of
the lower nodes. This is sufficient to stage the cancer accurately
and leaves some nodes and their drainage channels intact.
1. Nerve damage- There are three nerves in this
area that may be damaged during surgery.
The intercostobrachial nerve is a tiny sensory nerve that supplies
feeling to the skin on the inside of your arm. If it is
divided you may be left with some numbness under your arm. This
will not affect the strength or function of the arm.
The two other nerves are larger structures that are usually easily
seen and preserved. There is a 1% chance of them being damaged.
They supply muscles around the shoulder and if damaged can result
in weakness or altered function in the arm.
Fluid can accumulate under the arm after surgery causing swelling
and discomfort. A small plastic drain will usually be placed
through the skin at the end of your operation to drain this fluid.
Once the drain is removed the fluid may build up and can be drained
very simply in the clinic under local anaesthetic using a needle
and syringe. The fluid build-up usually stops within 2 -3
2. Stiff shoulder - Exercising the arm under the
supervision of a phyiotherapist will speed recovery and reduce the
risk of stiffness.
3. Stringing - You may feel a tight cord of tissue
running down the inside of your arm. This is caused by congested
lymphatic vessels. It usually improves with physiotherapy and
4. Lymphoedema - If your breast surgery involves
axillary node dissection there is a possibility that you could
develop some swelling of the arm on that side. This is called
lymphoedema and may occur soon after the operation or many months
later. The risk of clinically significant swelling is 5 - 10%. If
swelling occurs it may be not be easy to treat may become
Lymphoedema is due to a backlog of lymphatic fluid in the arm as a
result of damage to some of the small lymphatic channels in the
axilla. If radiotherapy is given to the axilla then the risk of
swelling is increased.
Lymphoedema can be difficult to treat and prevention is better
than cure. There are some simple measures that you can take to
reduce risk. We want you to avoid situations that could either
damage remaining lymphatics or that increase lymphatic flow.
- Protect the arm from sunburn
- Use gloves when gardening.
- Use an electric razor when shaving under your arm to avoid
- Avoid blood sampling and injections in the treated arm if
- Avoid prolonged, repetitive actions with the arm.
Use these guidelines to make sensible everyday decisions. They
are not meant to be excessively restrictive. Remember that one of
the aims of treatment is to get you back to your normal activities
as far as possible!
If you have any queries discuss them with your physiotherapist or
Breast Care Book
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advice on all aspects
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Meet the Surgeon
Trevor Smith MBChB FCS