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Axillary Dissection – Procedure, Risks & Recovery

Axillary dissection is a surgical procedure to remove lymph nodes from the armpit, most commonly performed in breast cancer treatment for staging and therapy.

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Things worth knowing about "Axillary Dissection"

Axillary dissection is a surgical procedure to remove lymph nodes from the armpit, most commonly performed in breast cancer treatment for staging and therapy.

What is Axillary Dissection?

Axillary dissection, also known as axillary lymph node dissection (ALND), is a surgical procedure in which lymph nodes located in the armpit (axilla) are removed. It is most commonly performed as part of the treatment for breast cancer, but may also be necessary for other cancers that spread to the axillary lymph nodes, such as melanoma or lymphoma.

Lymph nodes are small, bean-shaped structures of the immune system that filter lymphatic fluid and house immune cells. They play a central role in the spread of cancer cells throughout the body. When lymph nodes contain cancer cells, these are referred to as lymph node metastases.

When is Axillary Dissection Performed?

Axillary dissection is typically recommended when:

The sentinel lymph node (the first lymph node to receive drainage from the tumor) tests positive for cancer cells
Imaging studies show clearly involved lymph nodes in the axilla before surgery
Certain high-risk breast cancer situations require comprehensive lymph node removal
Other cancers affecting the axillary lymph nodes are present

How the Procedure is Performed

Axillary dissection is performed under general anesthesia. The surgeon makes an incision in the armpit and systematically removes the lymph nodes located there -- typically from Level I and Level II of the axilla (and rarely Level III). Usually between 10 and 20 lymph nodes are removed. The tissue is then analyzed histologically (under a microscope) to assess cancer involvement.

Levels of the Axilla

Level I: Lymph nodes below the pectoralis minor muscle
Level II: Lymph nodes behind the pectoralis minor muscle
Level III: Lymph nodes above the pectoralis minor muscle (removed only in selected cases)

Role in Diagnosis and Treatment Planning

Axillary dissection provides critical information about cancer staging and directly influences further treatment decisions. The number of affected lymph nodes is a key prognostic factor and helps determine whether chemotherapy, radiation therapy, or other systemic treatments are required.

Possible Complications and Side Effects

As with any surgical procedure, axillary dissection carries certain risks. The most common complications include:

Lymphedema: Accumulation of lymphatic fluid in the arm, leading to chronic swelling -- the most frequent long-term complication
Seroma: Collection of wound fluid in the surgical area
Numbness or tingling in the arm or armpit due to nerve irritation
Restricted shoulder movement
Wound infections and general surgical risks

Alternatives to Axillary Dissection

In recent years, sentinel lymph node biopsy has become an established, less invasive alternative. In this procedure, only the first draining lymph node is removed and examined. If it is found to be tumor-free, a full axillary dissection can be avoided, significantly reducing the risk of complications such as lymphedema. Current clinical guidelines recommend this minimally invasive approach when there is no clear clinical evidence of lymph node involvement.

Aftercare and Rehabilitation

Regular follow-up examinations are important after axillary dissection. To prevent and treat lymphedema, manual lymphatic drainage, compression therapy, and targeted physiotherapy are used. Patients should be informed early about protective measures for the affected arm to minimize the risk of lymphedema.

References

Deutsche Krebsgesellschaft (DKG) - S3-Leitlinie Mammakarzinom (German Breast Cancer Guideline), current version, AWMF Register No. 032-045OL
Lyman G.H. et al. - Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer. Journal of Clinical Oncology, 2017; 35(23):2692-2705
World Health Organization (WHO) - Breast Cancer: Prevention and Control. Available at: https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/

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