Axillary lymph node dissection

Lymph nodes move and filter fluids between body tissues and the bloodstream. Because of this, cancer cells often spread to the lymph nodes. An axillary lymph node dissection is surgery to remove lymph nodes from under your arm.

This surgery is usually done during your lumpectomy or mastectomy. During this surgery, your doctor will remove lymph nodes that have cancer and those that cancer could easily spread to. This surgery reduces the chance that the cancer could come back. It also helps your doctor plan further treatment for you.

After the surgery, you may go home the same day. Or you may need to spend the night at the hospital. You will probably be able to go back to work or your normal routine in 3 to 6 weeks. This depends on the type of work you do and any other treatment you may need.

After your lymph nodes are removed, you will be at greater risk for swelling in your arm. This is called lymphedema. You will have to take good care of your affected arm. Your doctor or physical therapist will tell you what to look for. They will also teach you how to take care of your arm.

This surgery may be done at the same time as other breast surgeries. If this is the case, how you prepare may be different.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Be active. It can help prevent problems and help you recover. Walking is a good option for many people.
• Avoid strenuous activities, such as biking, jogging, weightlifting, or aerobic exercise, until your doctor says it is okay. This includes housework, especially if you have to use your affected arm. You will probably be able to do your normal activities in 3 to 6 weeks. But for the next 3 to 6 months, be careful when you do tasks that use the same motions over and over, such as vacuuming, weed pulling, and window cleaning.
• For 4 to 6 weeks, avoid lifting anything that weighs more than 10 to 15 pounds or that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• Ask your doctor when you can drive again.
• You will probably be able to go back to work or your normal routine in 3 to 6 weeks. It will also depend on the type of work you do and any further treatment.
• You may be able to take showers (unless you have a drain near your incision) 24 to 48 hours after surgery. Pat the cut (incision) dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay. If you have a drain near your incision, follow your doctor's instructions to empty and care for it.
• Watch out for changes in your arm. Removing the lymph nodes in your armpit raises your risk of lymphedema. This is a condition in which fluid builds up and causes swelling.
  • Try to protect your hand and arm from injury and infection. Infection can increase your risk of swelling.
  • Keep your skin clean and moisturized.
  • Exercise as recommended by your doctor or physical therapist.

Diet

• You can eat your normal diet.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines.
  • Read and follow all instructions on the label. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off.
• After 24 to 48 hours, wash the area daily with warm, soapy water and pat it dry. Keep the area clean and dry.
• You may cover the area with a gauze bandage if it oozes or rubs against clothing. Change the bandage every day.

Exercise

• You will need to do arm exercises once your doctor tells you it is okay. Do the range-of-motion exercises as instructed by your doctor.

Elevation

• Prop up your arm on a pillow anytime you sit or lie down. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

• You may have a drain in your armpit. Follow your doctor's instructions to empty and care for it.