Axillary Dissection
Axillary dissection is the removal of the lymph nodes under your arm. The lymph nodes filter your body fluids. The nodes under the armpit, or axilla, help drain the breast fluids. Axillary dissection is not usually recommended for a diagnosis of DCIS (ductal carcinoma in situ). Since Sentinel Node Biopsy (the previous article) is not generally recommended for multicentric tumors (more than one location) or large tumors or women who have already had breast surgery, resulting in a large void in the chest cavity, it is important to recognize the pros and cons of axillary node dissection.
This surgery does not lead to a cure, but rather is an important diagnostic tool. Except for the fairly new SNB, there is no way to determine if cancer has spread to the lymph nodes without removing them. There are three levels of lymph nodes in the underarm area. The bottom lymph nodes are located just below the pectoralis major muscle. The second level of nodes lies under the pectoralis major muscle. The third level is above the pectoralis major muscle. There are also lymph nodes just above your collarbone, known as the supraclavicular nodes and there are internal mammary lymph nodes, within the breast itself.
This surgical procedure is usually done in conjunction with a lumpectomy, wide excision or mastectomy. I had my lymph nodes removed along with a wide excision. I was sedated, in the operating room, and went home the same day. The surgeon removes a clump of fat from under your arm and this tissue is sent to the pathology department. The lymph nodes are then painstakingly separated from the surrounding fat and examined for any evidence of cancer. There are not a set number of lymph nodes under your arm. Some woman will say, "My doctor took out 30 nodes", while another may have only have 10 removed. It does not matter how many nodes are removed - what counts is the number of nodes that are positive. (The higher the incidence of cancer in the nodes, the poorer the diagnosis). For the record, the doctor removed 15 of my nodes and they were all negative. The reason that the number of lymph nodes vary is based on your individual body structure, the exactness with which the pathologist searches for the lymph nodes and can only be made from the sample which your surgeon has sent to pathology.
You will generally be sent home with a drain attached to the surgical site. After approximately one - two weeks, you will have your drain removed and your stitches, if necessary.
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