If you have breast cancer, your doctor may recommend that you also have an axillary lymph node dissection done. This procedure has long been considered necessary in the overall treatment of breast cancer, to help prevent further spread or return of the cancer.

Learn more about how the procedure works, as well as what you need to know about potential complications and recovery.

An axillary lymph node dissection (ALND) is a procedure used in certain cases of breast cancer where the tumors have spread to the lymph nodes around your underarms (axilla).

This procedure may be recommended following the results of a sentinel lymph node biopsy. Depending on how many lymph nodes are suspected to be cancerous, your surgeon may remove between 5 and 30 of them with this procedure.

Your doctor recommend the following levels of treatment for axillary lymph nodes:

  • Level I means that the affected lymph nodes are located near the bottom edge of your pectoralis minor muscle. This muscle is located along your upper chest area. Level I is the least aggressive treatment.
  • Level II indicates that the area underneath your pectoralis minor muscle is affected.
  • Level III means that the lymph nodes are in the area above your pectoralis minor muscle. The removal of these tissues is considered the most aggressive level of ALND treatment.

An ALND is recommended if breast cancer has spread to axilla lymph nodes. Once removed, the lymph nodes are further evaluated to determine the extent of cancer tumors.

The overall goal of an ALND is to help prevent the further spread of cancer, as well as its return. This procedure is also associated with a higher survival rate.

Most cases of treatment involve Levels I and II. But sometimes a few nodes from Level III are also removed as a precaution. Your surgeon will also remove the “fat pad” located under your arm.

The actual lymph node removal process with an ALND takes about an hour. But depending on the facility as well as your response to surgery, you may be at the hospital for most of the day.

Before your surgery, you’ll be given general anesthesia. Your nurse will also check your vitals and have you fill out any last-minute paperwork.

During the procedure, your surgeon will cut a 2 to 3-inch incision in your underarm, usually along a crease to help minimize scarring. Then, the suspected cancerous lymph nodes are removed and your incision is stitched back together.

This procedure may be accompanied by a lumpectomy. If you have invasive breast cancer, an ALND may also be accompanied by a mastectomy.

After surgery, you’ll be sent to a recovery room where you’ll naturally wake up from anesthesia. A nurse will check your condition before determining when you’re ready to be discharged from the hospital.

In the meantime, the removed lymph nodes are sent for further examination to a pathologist. It may take several days until your doctor receives the final report.

ALND is considered major surgery, which requires home care before you resume your normal activities. You may experience swelling for up to a week after surgery, with full recovery expected within 4 to 6 weeks.

Before you leave the hospital, your doctor will give you pain medications to take as needed. You’ll also be given instructions on how to take care of your stitches and drains, and when you need to see your doctor for their removal.

You should be able to take a shower after 24 hours. But you should avoid bathing and swimming until your doctor gives you the go-ahead at your next checkup following surgery.

Also, avoid using lotions, deodorants, or powders around the affected area until your surgeon says it’s safe to do so.

Your doctor will recommend daily hand and arm exercises to help prevent complications while also improving swelling and mobility. A physical therapist may also help.

While an ALND may be necessary to prevent the further spread of breast cancer, this is a major surgery that does come with a risk of side effects. One clinical study found that ALND led to side effects in 42 percent of cases, but these side effects also ranged from minor to severe.

For example, the removal of lymph nodes may increase your risk of lymphedema. This condition occurs as a result of lymph fluid that collects in the area where your lymph nodes used to be.

Possible signs of lymphedema include:

  • swelling
  • tenderness
  • redness
  • numbness or tingling
  • fever
  • leathery skin
  • loss of movement in your arm(s)

Lymphedema may occur soon after surgery, or it can develop several months or years later.

Other potential side effects from an ALND include:

  • infections
  • bleeding
  • fluid retention under your arms
  • numbness
  • arm vein inflammation
  • blood clots

Call your doctor right away if you experience any of the above symptoms following your procedure.

An ALND is done to help stop the spread of cancer. To date, this procedure is considered necessary in:

  • providing an effective prognosis
  • stopping the further spread of breast cancer
  • increasing your overall chances of survival

An ALND is used to remove potentially cancerous tumors in the lymph nodes in your underarm area. This may be done in conjunction with other surgeries for breast cancer, and the goal is to help prevent further spread.

While an ALND may be a necessary step in your overall breast cancer treatment plan, it’s important to discuss all risks and potential complications with your surgeon in advance. Also, follow all aftercare guidelines carefully to help promote better healing and mobility.