Surgical Procedures: Axillary Lymph Node Dissection
Also Referred to as: Lymph node dissection; completion dissection; ALND
What is an Axillary Lymph Node Dissection?
A surgical procedure to remove lymph nodes from under the arm to find out if they have cancer cells in them. In the operating room, after you are asleep using general anesthesia, the surgeon will make an incision under the arm and remove most of the lymph nodes from that area. A surgical drain is then placed beneath the arm on the side of surgery to remove fluid and allow your body time to heal.
Will I Stay in the Hospital?
Most people can go home the same day or you may stay overnight. Your stay may be longer if other procedures are being done at the same time (i.e. mastectomy, reconstruction).
What is Recovery Like?
Your surgeon will discuss specific recovery issues with you. In general, you will be up and moving the day after surgery, with some limitations to your normal schedule and exercise routine in the first week or so. A surgical drain, placed at the time of surgery, is used to remove fluid that builds up after this procedure. It is placed under the arm on the side of surgery and stays in for approximately 7-10 days. When ready, it is removed in the office, a quick and often painless procedure. You will be given instructions on how to take care of the drain at home. After surgery, you could experience any of the following:
- Pain, numbness and/or sensitivity in the underarm or back of the upper arm.
- After the drain is removed, a seroma could develop. A seroma is when lymph fluid collects under the arm instead of draining its normal route. It is not worrisome, but can be uncomfortable. Most go away naturally, over time, but occasionally need to be drained in the office with a needle (an easy, painless procedure).
- Lymphedema, a chronic swelling in the arm and/or breast on the side of surgery. There is a risk of developing lymphedema after this procedure and this risk is lifelong. Discuss your risk with your surgeon. Learn more about lymphedema and what you can do to minimize your risk of developing lymphedema.
Can I Prevent Infections?
Getting an infection after lymph node dissection is not common. You can help prevent an infection by:
- Take a shower the night before surgery and wash your body with soap and water.
- On the second day after surgery make sure to shower or at least clean the incision with soap and water. Pat dry, do not rub the incision. Do this every day, or at least every other day, to keep the incision site clean.
- Do not immerse the incision site in water by soaking in a tub or swimming.
- Always wash your hands before and after touching the incision or changing the dressing.
What Will I Need at Home?
- 4 x 4 Gauze pads and 1-inch paper tape, which can both be found at your local supermarket or pharmacy.
- A specimen cup to measure fluid from the drain. This should be given to you by hospital staff before going home.
- Clean, comfy pillow(s) to put under your arm while sitting or to help with positioning at night.
- You may experience constipation after surgery due to anesthesia and pain medications. Over-the-counter medications, diet, exercise (as simple as walking) and fluids may ease constipation. Ask your health-care team about over-the-counter medications that may work for you.
Care of the Incision
If you have a post-surgical bandage, remove per your surgeon's instructions (often within 48 hours). Once the bandage is removed, you may shower but do not scrub the incision. To dry, carefully pat the incision with a clean towel. Avoid lotions, powders or deodorant on or near the incision during the first 1-2 weeks until it is fully closed.
Most surgeons use dissolvable sutures so you won't see any sutures and they don't need to be removed. On the outside, some surgeons use surgical glue over the incision to give added protection, others use paper tape called "steri-strips," while some use nothing at all. Both glue and steri-strips can get wet in the shower.
How Can I Help Myself?
Walking is good. Take rest periods throughout the day as needed. Move your arm on the side of surgery as naturally as possible; do not feel as if you have to guard the area.
Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.
- A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
- Find more relaxation exercises on OncoLink.
This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.