The lymph nodes under the arm are removed in order to test for the presence of breast cancer. This information is used to determine the best possible treatment options for breast cancer. There are two types of lymph node surgery done today: sentinel lymph node biopsy and axillary lymph node dissection.
This procedure identifies and removes the first lymph nodes to receive lymph fluid drainage from the breast. These nodes are called the sentinel lymph nodes. There is often more than one sentinel node. Once your surgeon has identified and removed the sentinel lymph nodes, they are sent to the pathologist for review and diagnosis.
Your surgeon will use a radionuclide dye, a blue dye, or a combination of both to identify the sentinel lymph nodes. The radionuclide dye is injected into the breast by your surgeon or by a radiologist in the nuclear medicine department. This is done before your scheduled surgery, sometimes the day before surgery. The amount of radiation exposure is less than a routine chest X-ray.
If blue dye is used, it will be injected into your breast by your surgeon in the operating room. You may notice a blue discoloration of your breast after surgery. This will fade in time. You may also notice a blue-green discoloration of your urine or other bodily fluids immediately after surgery.
An axillary lymph node dissection removes all of the lymph nodes in the lower armpit area (known as the axilla). The fatty tissue that is removed with an axillary node dissection usually contains between six to twenty-five lymph nodes. The precise number of lymph nodes removed will not be known until the tissue is examined microscopically by the pathologist.
There are several factors that your surgeon will consider to determine if you need an axillary node dissection. These factors can include:
A: Possibly. Your surgeon will decide if a drain is needed to remove the lymph fluid from the surgical area. If a drain is placed, you will be given drain care instructions. The drains are removed in the clinic once it drains less than 25 cc (ml) of fluid over a 24 hour period x 2 days in a row.
If no drain is placed, or after a drain is removed, it is possible to collect fluid under the incision. This is not harmful, although it can be uncomfortable. Contact your surgeon if this occurs, as the fluid can be easily removed in the office with local anesthetic and a small needle to aspirate (draw out) the fluid collection.
A: Generally there is more discomfort after axillary dissection than after a sentinel lymph node biopsy, but each patient has a different experience. You may experience post-operative pain at the incision, and possibly your back and upper arm.
A: You may remove the gauze bandage on the day after surgery. Leave the thin paper strips (steri-strips) in place. You may shower and get the strips wet. Just pat the area dry when you are done. The strips will start to come off in about a week.
Do not use deodorant until instructed by your surgeon, as it may irritate your incision. (Usually you may resume in 1-2 weeks.)
Do not shave the underarm until your incision is well healed. Watch in a mirror when you do shave, since you may have decreased sensation in that area.
A: You may use your arm as much as it is comfortable to do so. The discomfort will lessen over a week or two, and you can increase your activity level as you feel better. It is not unusual to experience a “pulling” under your arm and have some restriction initially after surgery. Most patients benefit from therapy to help return to full arm function after surgery—such as the Saratoga Hospital Comprehensive Rehabilitation Program for Women with Breast Cancer. Your surgeon can make a referral.
A: Because lymph nodes have been removed from under the arm, it is important to watch out for and prevent infections in the arm on that side. Avoid cuts, scratches, irritations and burns as much as possible by doing the following:
A: Driving will not hurt your surgical recovery, but you must think about safety. You should not drive if you are still taking prescription pain medication. You should also wait until you can move your arm easily. It is best to drive only short distances at first and gradually increase your driving time over a few days.
Stay in Touch
Sandy B, Patient
Patty F, Patient