Axillary Lymph Node Dissection

Because my cancer had spread to my lymph nodes, I had to undergo a lymph node dissection, where my surgeon removed all the lymph nodes under my arm.  When I was first diagnosed, my biopsies indicated that I had two known lymph nodes affected, however they only tested two so there could have been more.  That’s why elsewhere in my blog I’ve said I was originally stage IIB but was probably stage III, because they only tested 2 lymph nodes.  If I had another other lymph nodes affected, I would have been stage III and after surgery my surgeon said I likely had others affected because the lymph node pocket they removed didn’t have the full number of lymph nodes they would have expected, meaning they were killed by the chemo and only lymph nodes with cancer would have been killed.  Anyway, here is an overview (source: of the lymph node dissection surgery and the possible risk factor, lymphadema, which I’ll have for the rest of my life. 

If you have invasive breast cancer, your surgeon will probably remove some of the lymph nodes under your arm during your lumpectomy or mastectomy. Examining your lymph nodes helps your doctors figure out the extent of cancer involvement. Cancer in the lymph nodes is associated with an increased risk of having cancer cells in other parts of your body.

Lymph is a clear fluid that travels through your body’s arteries, circulates through your tissues to cleanse them and keep them firm, and then drains away through the lymphatic system.

Lymph nodes are the filters along the lymphatic system. Their job is to filter out and trap bacteria, viruses, cancer cells, and other unwanted substances, and to make sure they are safely eliminated from the body.

One main lymph node area (the armpit, or “axilla”) and two secondary lymph node areas (the internal mammary and supraclavicular regions) filter the lymph fluid draining away from the breast area.

Since the job of the lymph nodes is to filter out “bad guys” like cancer cells, this is a logical place to look for breast cancer cells that have escaped the original tumor and are trying to go elsewhere in the body.

Your lymph nodes act as filters for your body’s lymphatic drainage system. That’s why the lymph nodes are likely to “catch” or filter out cancer cells that might be floating in the fluid that drains away from the cancerous area of the breast. Doctors look at the different kinds of nodes that are involved with your breast:

  • The nodes around your collarbone and neck (supraclavicular, infraclavicular, and cervical nodes) are examined manually (by hand). Your doctor will feel this area for signs of enlarged nodes.
  • The nodes under your arm (axillary lymph nodes) are also examined manually and are relatively easy to get to during surgery. Surgery to remove some or all of the lymph nodes under your arm is called axillary lymph node dissection.

There are three levels of axillary lymph nodes (the nodes in the underarm or “axilla” area):

  1. Level I is the bottom level, below the lower edge of the pectoralis minor muscle.
  2. Level II is lying underneath the pectoralis minor muscle.
  3. Level III is above the pectoralis minor muscle.

A traditional axillary lymph node dissection usually removes nodes in levels I and II. For women with invasive breast cancer, this procedure accompanies a mastectomy. It may be done at the same time as, or after, a lumpectomy (through a separate incision).

Based on the doctor’s physical exam and other indicators about the likelihood that cancer has spread to your lymph nodes, the surgeon will generally remove between five and thirty nodes during a traditional axillary dissection. The total number of lymph nodes “involved” (showing evidence of cancer) is more important than the extent of cancer in any one node.

Your doctor will let you know if any lymph nodes were involved (and if so, how many), as well as the extent of tumor involvement in each node.

Lymphedema (pronounced LIMF-eh-DEE-ma) is a side effect that can begin during or after breast cancer treatment. It isn’t life threatening, but it can last over a long period of time. This condition involves swelling of the soft tissues of the arm or hand. The swelling may be accompanied by numbness, discomfort, and sometimes infection.

There’s no reliable way to find out your level of risk for lymphedema, but by taking proper precautions you CAN greatly reduce your chances of developing the condition.



One Response to “Axillary Lymph Node Dissection”

  1. Marla Slisn Says:

    I don’t have breast cancer. Squamous cell carcinoma was found in a lymph node under my arm. Two mammograms that were perfect. Two ultrasounds showed one enlarged node which tested positive for squamous in the biopsy. I’m scheduled for axillary lymph node dissection under my right armpit in a week. I’m very scared if lymphedema. Any suggestions? By the way I’m a court reporter by profession and am afraid of not having use of my arm and hand.

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