​Summary:

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An axillary lymph node dissection (ALND) is a surgical procedure that removes multiple lymph nodes from the armpit (axilla) to assess and treat the spread of breast cancer. It is usually performed when cancer is confirmed in the lymph nodes or when a sentinel node biopsy shows significant involvement. This operation helps determine the stage of cancer and guides further treatment such as radiotherapy or chemotherapy.

 

At the Breast & Wellness Centre, we use a refined technique with a small, hidden incision to minimise discomfort, preserve shoulder movement, and reduce the risk of lymphoedema. Every patient also receives specialised lymphoedema care before and after surgery to protect lymphatic function and prevent complications.

 

What is an Axillary Lymph Node Dissection?

 

The lymph nodes in the axilla are part of the lymphatic drainage system and are often the first site where breast cancer can spread.

An axillary lymph node dissection removes lymph nodes from levels I and II of the axilla (under and behind the pectoralis minor muscle). Occasionally, level III nodes (beneath the collarbone) may also be removed if required.

 

This procedure provides critical information for cancer staging and prevents further spread within the lymphatic system. It is typically performed after a positive sentinel node biopsy or when imaging or needle biopsy has already shown cancer involvement.

 

Before the Procedure

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• You will meet your surgeon and anaesthetist to discuss the procedure and ask any questions.

• Bring your breast imaging and pathology reports if performed outside the hospital.

• Axillary dissection is commonly performed together with lumpectomy or mastectomy under one anaesthetic.

• You’ll arrive fasting, as instructed.

• The surgeon will mark the site before surgery.

 

Lymphoedema Assessment:

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At the Breast & Wellness Centre, every patient undergoing axillary surgery is reviewed by our lymphoedema therapistboth before and after surgery.

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• Preoperative assessment identifies any existing lymphatic drainage issues, asymmetry, or swelling.

• Postoperative assessment monitors for early signs of lymphoedema, allowing timely management and rehabilitation if needed.

 

In suitable candidates, we also perform lympho-venous anastomosis (LVA) — a microsurgical technique that connects tiny lymphatic vessels directly to nearby veins. This advanced procedure helps maintain lymph flow and significantly reduces the risk of postoperative lymphoedema.

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During the Procedure

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• Anaesthesia:

  • The operation is performed under general anaesthetic, so you’ll be asleep throughout.

• Incision:

  • A small incision is made in a natural skin crease under the arm or, when possible, through the breast incision to avoid an extra scar.

• Lymph Node Removal:

  • The surgeon removes the lymphatic tissue containing the nodes from the axilla — usually 10 to 20 nodes, depending on anatomy.

  • The intercostobrachial nerve (which supplies sensation to the inner arm) is preserved whenever possible to reduce numbness.

  • Blood vessels and lymphatic channels are carefully sealed to minimise fluid buildup.

• Drain Placement:

  • A small drain is inserted to collect fluid from the area and is usually removed within 5–7 days once drainage is minimal.

• Closure:

  • The wound is closed with dissolvable sutures and covered with a waterproof dressing.

• Duration:

  • The operation takes about 45–60 minutes when performed alone, or longer if combined with breast surgery.

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After the Procedure

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• You’ll recover in the ward and usually stay overnight.

• The drain is typically removed after several days, depending on fluid output.

• Some mild bruising, tightness, or numbness in the inner upper arm is common and gradually improves.

• Your dressing is waterproof, and you can shower from the day after surgery.

• If breast surgery was performed, continue wearing your own surgical bra or chest garment as advised.

• Gentle shoulder and arm exercises are essential to maintain movement and reduce stiffness — these will be demonstrated by our physiotherapy team.

• Avoid heavy lifting or repetitive upper-arm activity for about two to three weeks.

• Driving is permitted after your first postoperative review, once movement is comfortable and you’re no longer taking strong pain medication.

 

Postoperative Lymphatic Care:

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• You will be reviewed again by our lymphoedema therapist to assess lymphatic recovery and drainage.

• If any swelling or fluid collection occurs, early intervention (massage, compression therapy, or physiotherapy) is provided to prevent chronic lymphoedema.

• Patients who underwent lympho-venous anastomosis will receive specific monitoring to ensure continued lymphatic function.

 

Pathology results are usually available within 7–10 days and will be discussed at your follow-up appointment to guide further treatment.

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Possible Risks and Side Effects

 

Although axillary dissection is a safe and well-established procedure, potential risks include but not limitted to:

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• Bleeding or haematoma

• Infection

• Seroma (fluid collection under the arm)

• Temporary or permanent numbness in the inner upper arm

• Shoulder stiffness or limited range of motion

• Tingling or discomfort due to nerve irritation

• Lymphoedema (arm swelling) — occurs in 10–20% of patients without intervention, but risk is significantly reduced with LVA and early therapy

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Benefits of Axillary Dissection

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• Provides accurate information on lymph node involvement for staging and treatment

• Removes cancer-affected lymph nodes to prevent local recurrence

• Guides decisions about radiotherapy and chemotherapy

• Can be performed through a hidden or shared incision for better cosmetic results

• Supported by comprehensive lymphoedema care at Breast & Wellness

• In suitable patients, lympho-venous anastomosis further lowers the risk of long-term swelling

• Modern surgical and physiotherapy protocols result in faster recovery and reduced complications

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Key Points

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• Removes lymph nodes from the armpit for staging and cancer control

• Usually performed together with lumpectomy or mastectomy

• Small, hidden incision — often through the breast fold

• Drain in place for several days

• Lymphoedema therapist assessment pre- and post-op at Breast & Wellness

• Lympho-venous anastomosis (LVA) may be performed to protect lymphatic flow

• You can shower from the day after surgery

• Gentle arm exercises essential for recovery

• Driving permitted after your first postoperative review

• Risk of lymphoedema significantly reduced with early therapy and modern techniques

• Typical hospital stay: overnight, with close postoperative follow-up