Prior to the late 1990s, anyone diagnosed with invasive breast cancer, even those with normal-appearing lymph nodes, underwent an axillary lymph nodes dissection. With this operation most of the lymph nodes in the axilla (arm pit) are removed.If less that 10 lymph nodes were removed it was sometimes considered an inadequate dissection and a second operation may have been performed to obtain more lymph nodes.
The problem was that in 40% of patients (that’s 2 out of 5) there was no cancer in the lymph nodes. So now those patients were missing normal lymph nodes and were at risk for complications such as lymphedema.
That sounds terrible but we must keep things in perspective: Axillary lymph node dissection was the only tool available at the time and most patients benefited from it. It would have been much worse not to remove malignant lymph nodes and have the cancer invade the nerves and blood vessels in the axilla and erode into the ribs. I have seen this way too many times and it is beyond terrible.
Today, it still necessary to perform an axillary lymph node dissection in select patients. In my opinion, it is an elegant operation that can be technically demanding especially if the cancer involves the major blood vessels and nerves supplying the arm. Personally, over the years, I have done this operation hundreds of times. At a minimum it takes one and a half hours but I’ve had cases that took 5 hours. In the proper hands, the complication rate is relatively low and all my patients have maintained normal arm function. A drain is placed as usually stays in in for 10 to 14 days. It is easily removed in the office. The problem is that because a lot of lymph nodes were removed, there is a risk of lymphedema. All my patient who undergo axillary lymph node dissection are evaluated by our physical therapists preoperatively and baseline arm measurements are obtained. Then they see the therapist postop after the drains are removed.
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