Axillary Lymph Node Dissection

Overview

Breast cancer can spread to the nearby lymph nodes in the underarms (axillary). The affected lymph nodes must be removed (dissection). This helps stop the cancer from spreading. Axillary lymph node dissection (ALND) is a procedure to remove these lymph nodes.

ALND happens after cancer cells are found during a sentinel lymph node biopsy.

ALND can remove lymph nodes located above, below or directly underneath a muscle that runs along the side of the upper chest. This muscle is known as the pectoralis minor muscle.

• Level I — remove all the tissue below the muscle
• Level II — remove the tissue directly underneath the muscle
• Level III — remove the tissue that is above the muscle (this is the most aggressive surgery)

Cancer cells are often removed from the breast at the same time as ALND. This surgery is known as a lumpectomy or a mastectomy.

ALND can raise the risk of:

• Lymphedema
• Infection
• Bleeding
• Build up of fluid under the arm
• Numbness under the arm

When lymph nodes are removed, the liquid they store (lymph) can begin to collect in the area. More lymph nodes are removed with ALND, which raises the risk of lymphedema.

Patients with lymphedema are more likely to have an infection in the affected arm. Patients must carefully watch for swelling or changes.

The best treatment of lymphedema is to prevent it. Physical therapy can help treat the condition when it occurs.