Surgical Procedures: Axillary Lymph Node Dissection

Also called: Lymph node dissection, completion dissection, ALND

What is an Axillary Lymph Node Dissection?

Axillary lymph nodes are found under the arm (axilla means armpit). An axillary lymph node dissection is the surgery done to remove these lymph nodes. This is done to find out if they have cancer cells in them.

• In the operating room (OR), you will be given anesthesia to put you to sleep.
• The surgeon will make an incision (cut) under the arm and remove most of the lymph nodes from that area.
• A surgical drain is placed under the arm on the side of surgery to remove fluid and to give your body time to heal.

Will I stay in the hospital?

Most people can go home the same day, or you may stay overnight. You may stay longer if other procedures are being done at the same time (such as a mastectomy or reconstruction).

What is recovery like?

Your healthcare team will talk to you about your recovery. Often, patients are up and moving the day after surgery. You will need to make some changes to your activity level in the first week or so. If a surgical drain was placed during surgery, it will stay in for about 7-10 days. It will be removed in your provider’s office, which should be quick and is often painless. You will be given instructions on how to take care of the drain at home.

What are possible side effects?

• Pain, and/or feeling numb or sensitive in the underarm or back of the upper arm.
• After the drain is removed, a seroma could develop. A seroma is a pocket of fluid under the arm. It is not serious but it can be uncomfortable. Most go away on their own over time. In some cases, they need to be drained in the office with a needle.
• Lymphedema, a long-term (chronic) swelling in the arm and/or breast on the side of surgery can happen any time after surgery. Talk about your risk with your care team. Learn more about lymphedema and what you can do to lessen 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:

• Taking a shower the night before surgery and washing your body with soap and water.
• Not putting the incision site under water (soaking in a tub or swimming).
• Always washing your hands before and after touching the incision or changing the dressing.

What will I need at home?

• Gauze pads (4x4) and 1-inch paper tape, which can both be found at your local supermarket or pharmacy. These can be used to cover the incision.
• A specimen cup to measure fluid from the drain. This should be given to you by your care team before going home. Write down how much fluid drains in a notebook.
• Clean, comfy pillow(s) to put under your arm while sitting or to help with your position at night.
• You may have constipation after surgery. Over-the-counter medications, adding fiber to your diet, exercise (as simple as walking) and fluids may ease constipation. Ask your care team about over-the-counter medications that may work for you.

How do I care for the incision?

If you have a bandage after surgery, remove when your provider’s instructions say to do so (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. Do not use 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 (stitches) inside your body, which will go away on their own. On the outside, your surgeon may use surgical glue, paper tape called "steri-strips" or nothing at all. Both glue and steri-strips can get wet in the shower.

How can I help myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.