Axillary node clearance

This procedure may be undertaken on its own but most times it is performed in combination with a mastectomy or wide local excision under a general anaesthetic. Lymph nodes are small oval shape tissues normally located in areas draining fluid back to the main body. Their function is to capture any bacteria or abnormal tissue and prevent them from reaching the main body. Cancer cells released by a tumour therefore drain through its nearest lymph nodes. Once captured the cancer cells can grow in the lymph node indicating that the cancer has gained the ability to spread (metastasise) to the rest of the body. In the case of breast cancer the lymph glands most commonly affected are the ones in the armpit (axilla).

Axillary node clearance is performed if cancer has been identified in the axillary nodes either through an ultrasound guided biopsy as part of the initial breast cancer tests or through a sentinel node biopsy. This procedure aims to remove all of the lymph nodes from the axilla in order to remove cancer that has spread. A surgical cut is made in the axilla and all the lymph nodes are removed. The wound is then closed with dissolvable stitches and the lymph nodes are later examined in the laboratory to check how many contain cancer. A small drain is usually left in the wound to help drain any fluid and/or blood to prevent the development of a collection and infection. The drain is usually removed 24hr to a few days later.

Recovery

After the procedure you will wake up in a hospital room. If this is the only procedure performed you can usually go home on the same or next day. You are typically expected to go home once you are eating and drinking and are able to manage the pain. It normally takes about two to four weeks to fully recover from this procedure and return back to work but it varies from person to person and depends on their general health and the nature of their work. Once at home it is important to get adequate rest and perform shoulder exercises to reduce the risk of getting a stiff shoulder. For the first four weeks you should avoid any heavy lifting or repetitive movements (ironing, vacuuming), avoid swimming or playing sport, avoid driving until you are confident.

Procedure risks

Axillary node clearance is a safe procedure. Sometimes though you may experience some numbness or tingling around the armpit or under your arm. This usually goes away with the healing but sometimes it may persist permanently. There is also a small risk of infection or a collection of fluid (seroma) as well as a risk of swelling of the arm (lymphoedema). Shoulder stiffness because of not moving the arm adequately may also occur. Shoulder and arm exercises generally help reduce the risk of shoulder stiffness and reduce the lymphoedema.