How is the Axillary Lymph Node Procedure Done

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Axillary Node Dissection Overview

Lymph nodes located in the armpit or in the axilla are called axillary lymph nodes. They are generally divided into three levels. Level I lymph nodes are situated below the pectoralis minor muscle, a triangle-shaped muscle in the upper chest. Level II lymph nodes are underneath of the pectoralis minor muscle, and level III are the lymph nodes that are found above this muscle.

During the axillary node dissection procedure, the level I and II nodes are removed. This is frequently done when a mastectomy or a lumpectomy procedure is being performed on women with breast cancer that have become invasive.

The purpose of the procedure is to determine if the cancer in the breast has metastasized to the surrounding tissues. If the cancer cells have spread to the lymph nodes, it usually means that the cancer has gone beyond the breast and the patient may need to have an intensive treatment course. The result of the surgery frequently determines the best and proper course of therapy.

Preoperative Procedure

Days before the surgery, the general health condition of the patient is assessed by doing several tests such as blood tests, EKG and chest x-ray. Any maintenance medications being taken by the patient should be disclosed during this time, especially when he is taking medications that make the blood thin. Eight hours before the surgery, the patient is advised to undergo fasting.

Intraoperative Procedure

The patient is generally unconscious during the entire axillary node dissection procedure. After the anesthesiologist have given the anesthesia, the surgeon makes an incision underneath the arm and fat pads and proceed to remove about 10 to 20 lymph nodes. The incision wound is then sutured and the surgeon may put a drain to take out excess fluid. The procedure usually takes about one to two hours to complete.

Postoperative Care

The patient is wheeled into the PACU or post-anesthesia care unit for close monitoring until he becomes conscious. As soon as the patient has gained consciousness and vital signs are stabilized, she will be transferred to a regular room.

Patient Recovery

The patient is expected to be fully recovered from the procedure after 6 weeks. In that span of time, the patient must refrain from lifting heavy objects and doing strenuous activities. During the follow-up consultation, the doctor often assess for sensation loss in the arm which may occur as a result of nerve injury during the procedure.


Common complications experienced by most patients after an axillary node dissection procedure are lymphedema, permanent numbness in the incision area and infection. Any redness, pain, bleeding and swelling should be reported immediately to the attending physician as they may be signs of infection. The patient may also develop keloid formation underneath the arm or may notice changes in the size and shape of the breast.

References Axillary Dissection

Encyclopedia of Surgery: Axillary Dissection