Axillary Lymph node clearance
The axilla is a medical term used to describe the armpit. There are approximately 20 lymph glands in the armpit. The lymph glands are the most common site to which breast cancer spreads. Lymph node clearance aims to remove all the lymph glands to check first whether any of the glands are affected and if so exactly how many are involved, and second to remove the glands so that if they are affected, no cancer is left behind. The operation is performed through a cut (incision) in your armpit just below where your hair grows. At the end of the operation the wound is closed with an deep stitch that does not need to be removed. A drain is placed to remove excess fluid. This is usually removed the following day.
Problems which can happen after axillary node clearance
The axilla is a medical term used to describe the armpit. There are approximately 20 lymph glands in the armpit. The lymph glands are the most common site to which breast cancer spreads. Lymph node clearance aims to remove all the lymph glands to check first whether any of the glands are affected and if so exactly how many are involved, and second to remove the glands so that if they are affected, no cancer is left behind. The operation is performed through a cut (incision) in your armpit just below where your hair grows. At the end of the operation the wound is closed with an deep stitch that does not need to be removed. A drain is placed to remove excess fluid. This is usually removed the following day.
Problems which can happen after axillary node clearance
- Bleeding- Even though all visible bleeding is stopped during the operation, bleeding can start from the edges of the wound after the operation and cause blood to collect in the wound. This is uncommon and happens in about 1 in every 100 patients. The normal time for this to develop is within the first 12 hours after operation. Because of this possibility your wound is checked regularly following surgery.
- The most common problem is pain, swelling and discomfort under the arm which lasts for a few weeks. Do not be afraid to take regular pain killers. Ensure the arm keeps mobile by practising the exercises taught to you while in the ward.
- Seroma- The fluid which normally passes through the lymph glands can cause a swelling under the arm. Sometimes this needs to be removed with a needle and syringe. The build up of fluid which is called a seroma occurs in about two thirds of women following axillary node clearance. Some people need this fluid drained on a number of occasions but this is not an important problem and usually settles within a few weeks of surgery.
- Numbness: there are nerves which pass through the armpit to the inner side of the arm. These nerves are sometimes damaged during removal of all the lymph glands. Your surgeon will make every attempt not to damage these nerves. Even if the nerves are not cut they will be stretched and it takes some time after the operation before the feeling returns. You should be prepared therefore for some slight loss of feeling in the upper inner part of the arm on the side of the surgery. In about half of patients this will be recovered over the first few months after operation but it can persist lifelong.
- Shoulder stiffness: you will be taught a series of exercises after the operation. It is important that these are carried out. Shoulder stiffness and reduction in movement of the shoulder is a common problem in those who do not manage to do their shoulder exercises. You may get some pain and discomfort after the operation and you may experience soreness when performing your exercises. Do not be afraid to take regular painkillers after the operation as this will make it less painful and allow you to do your exercises with less discomfort. During this period of recovery there may be some pain or discomfort down the inside of your upper arm but this usually settles after a few weeks.
- Arm swelling: The removal of lymph nodes from the axilla may result in swelling affecting your arm and /or breast. This is called lymphoedema. This can occur in up to 1 in 5 patients though in many patients it is mild. There are exercises, massage and compression garments available to control the symptoms of lymphedema, but it can persist for life.