Lymph node surgery

Your surgeon will most likely remove some lymph nodes from under your arm during your breast cancer surgery (lumpectomy or mastectomy). The medical term for armpit is "axilla," so any lymph nodes from this part of the body are called "axillary" lymph nodes.

With lumpectomy, a separate incision is needed to remove the lymph nodes under the arm. With mastectomy, the lymph nodes can be removed through the same incision as the tumor and breast tissue.

The lymph nodes are removed and examined under a microscope to help your doctors determine whether the cancer has spread beyond the breast. Cancer in the lymph nodes is associated with an increased risk of having cancer cells in other parts of your body.

• Node-positive means that cancer cells were found in the lymph nodes.
• Node-negative means there were no cancer cells found in the lymph nodes.

Knowing whether your breast cancer is node-positive or node-negative is very important in helping you and your doctor determine the best course of treatment for you.

Sentinel lymph node biopsy

Sentinel lymph node biopsy is the removal of a few selected lymph nodes and is less extensive than axillary lymph node dissection. The purpose is to determine whether more extensive lymph node surgery is required.

• In this procedure, a radioactive dye is injected into the breast near the tumor.
• The dye travels from the breast to the lymph nodes in the underarm.
• The first lymph node(s) that absorbs the dye is called the sentinel lymph node(s).
• The sentinel lymph node(s) is removed and sent for testing.
• If cancer cells are found in the sentinel node(s), you are considered node-positive, and then an axillary lymph node dissection is done.
• If cancer cells are not found in the sentinel node(s), you are considered node-negative, and an axillary lymph node dissection is not required.

Axillary lymph node dissection

This procedure involves the removal of 10-15 additional lymph nodes to evaluate the extent of the spread of cancer to the lymph nodes. The number of nodes found to contain cancer is important in determining your best course of treatment and risk of recurrence.

What to expect with lymph node surgery

The following section discusses common effects of lymph node surgery. If you had a sentinel node biopsy, you have a lower risk of experiencing these effects, but they may still occur.

Immediately after surgery, swelling may occur in the affected area due to fluid build-up. A temporary drain may have been inserted during surgery to reduce the fluid build-up. You may also have numbness, pain, or stiffness under the arm on the side of the surgery. Exercise and physical therapy may help reduce numbness and pain and relieve stiffness.

If you have sentinel lymph node biopsy you have a lower risk of experiencing these side effects. However, even with this less invasive procedure you might still experience pain, numbness, or even lymphedema.

Lymphedema

The removal of lymph nodes from the underarm may prevent proper drainage of the lymph fluid from the arm to the rest of the body. As a result, lymph fluid may build up in the arm, which is called lymphedema. The accumulation of lymph fluid in the hand and arm can result in swelling, which could lead to numbness and pain.

Arm lymphedema can occur immediately after surgery or years later. Most women do not develop lymphedema following lymph node dissection, and it is not possible to predict who will develop it. Lymphedema is a permanent condition that may be managed through specific exercises, massage, and compression sleeves.

Some of the ways to prevent and manage lymphedema include:

• Protect yourself from cuts, scratches, burns, and sunburn, which are risks for infection. Your body responds to infection by making extra fluid, and this can trigger lymphedema. If any of these occur, wash the area with soap and water and apply an antibiotic cream or ointment. Call your doctor right away if signs of infection develop, such as rash, red blotches, swelling, increased heat, tenderness, or fever.
• If you need an injection or blood drawn, ask to have it done in your unaffected arm or somewhere else, such as the hip.
• Avoid excessive heat, including hot tubs and saunas. Heat can increase fluid build-up in the affected arm.
• Wear jewelry, clothing, and gloves that are not too tight. Wear a loose-fitting bra with padded straps. Constriction or squeezing of the arm and shoulder can lead to increased fluid and swelling.
• Before doing any strenuous exercise, such as weightlifting or tennis, talk with your doctor, nurse, or physical therapist to decide what level of activity is right for you.

For more information on avoiding and managing lymphedema, talk to your doctor. You may also visit breastcancer.org.