Lymph Node Dissection: What to Expect

How long surgery takes

Surgery takes about an hour. The process of being admitted and prepared for surgery will vary from place to place. The amount of time you spend in the recovery room, waking up and getting to the point that you're ready to go home, will vary from woman to woman.

The incision

Most surgeons make a two–to–three–inch incision in the skin crease under your arm.

What happens

General anesthesia is used. Most commonly, the lower two levels of the three levels of axillary nodes will be removed. Occasionally, a surgeon will take one or two nodes from the top level, as an extra precaution. If you have a modified radical mastectomy, the lymph node dissection usually occurs in the same operation. If you have a lumpectomy, the lymph node dissection may occur at the same time or in a later operation. Once the surgeon removes the nodes, a pathologist will examine them carefully for signs of cancer. It may take days before the pathology report is available.

The risks

• Lost or decreased sensation in the back of the arm or armpit. Sometimes the nerve supplying sensation to the back of the arm and armpit is cut, stretched, or damaged during surgery. This loss of sensation may be temporary, but for some women it may persist.
• Tingling, numbness, stiffness, weakness, or lymphedema (swelling of the arm). It's important not to let your arm become weak and stiff as a result of discomfort and limited range of motion (mobility) after surgery. Physical therapy and exercise can help restore your arm movement and strength.
• Inflammation of the arm veins as they pass through the armpit region. This inflammation can show up several days after surgery, and usually responds to treatment with ice and aspirin within several days. Occasionally a clot can form in the affected vein.
• Winged scapula. This is an extremely rare complication that happens when the motor nerves that hold your shoulder blade flat are damaged, causing your shoulder blade to stick out when you hold your arm out straight. Again, this is extremely rare, and is usually not a problem in daily activities.
• Increased risk of infection in the surgical area. This is usually discovered early and responds well to treatment.