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Helping you through breast cancer treatment

Taking out those lymph nodes: auxiliary node dissection

Taking out those lymph nodes: auxiliary node dissection

If your breast cancer has spread to your lymph nodes then you will have some or all of your lymph nodes removed during your breast surgery (whether a lumpectomy or mastectomy).

What the blazes is a lymph node?

To be honest, before I had mine whipped out, I didn’t really know anything about lymph nodes. My non-techy understanding now is that the lymphatic system of the body is a system of tubes carrying lymphatic fluid (lymph vessels) and lymph nodes around the body helping to fight off infections. The lymph nodes in the armpits are the gateway between the lymphatic system in the arm and rest of the body. They act as a filter or drain: bacteria, dead cells, cancer cells from your arm and breast area are caught here.

The Cancer Research UK website explains lymph nodes and the lymph system really well.

Why do I need them removed?

Your breast surgeon will want to remove your lymph nodes if cancer cells have been found in them (they will have tested them using an ultra sound scan, a biopsy or a sentinel lymph node biopsy which is where they take a sample of cells in the lymph node and have them tested).

It is important to discuss with your breast consultant how many lymph nodes he/she is planning to remove. Some of us have to have them all removed, others just need to have some removed.

What happens if the lymph nodes are removed?

In non-tech jargon, this is what I understand happens when the lymph nodes are removed:

· The lymph nodes in the armpits are the gateway between the lymphatic system in the arm and rest of the body. Lymph vessels leave the nodes, go down the arm, back up the arm to the nodes.

· When the lymph nodes are removed, the lymph vessels in the arm don’t have an anchor and they basically shrivel up and disintegrate. This disintegration process takes from a few weeks to a few months. And the shriveled up lymph vessels can harden like guitar strings which limit your movement in that arm – you can’t lift the arm up very far. This is called cording. Cording can also occur in the armpit itself as a result of scar tissue.

· Because the lymph vessels are shriveling up and not anchored to the rest of the body’s lymphatic system, the lymph fluid in the arm needs to go somewhere and this is why you have a drain attached to your armpit immediately after surgery. The lymph fluid from the arm goes out of the body via a tube into a bag. This is the drain.

· After a few days the drain is removed. This is a very simple procedure which doesn’t hurt and basically involves the tube being taken out and sometimes a stitch where the tube was located.

Online information about lymph node surgery

Breast Cancer Care  

Cancer Research UK

Prep and planning for lymph node removal surgery

1. Find a small, soft, squidgy cushion or pillow that you can put under your arm after surgery.
2. Plan how you will sleep at night when you get home from hospital – you may have a drain attached to your armpit and so you will need to think about extra cushions for sleeping upright and something beside the bed to hook the drain tubes over.
3. Get contact numbers for who to call about any questions to do with the recovery and drain – especially in the immediate days after the surgery (24 hour contacts).
4. Plan and freeze some meals because you won’t be up to much in the kitchen.
5. Plan childcare and school runs for the day of, and a few days after, surgery.
6. Get some flannels or sponges – you can’t have a shower for a few days after surgery so you will need to wash in a low bath or at the sink.
7. Think about what you can wear to accommodate the tubes and drain coming out of your armpit and that you can put on without really moving your arm – a big t shirt with big arm holes that you can fit over your head, or front fastening tips like shirts or zip tops.
8. For a while after surgery you can’t shave or wax your armpit so get de-fuzzing pre-op.
9. Pack a bag for the hospital stay, include items such as:
Wash bag of toiletries
Clean undies
Something to do like a book, magazine, downloaded film on an iPad/phone.
10. You will have drain coming out of your armpit which is tube and bag to collect the lymphatic fluid. You can get a drain bag to pop over your arm and carry around the drain. This helps by carrying the tube and bag, and it also hides it. I found a super website which makes and sends drain bags to ladies having this surgery (www.draindollies.co.uk).

The surgery

1. You will probably stay overnight or longer.
2. A breast surgeon will carry out the operation.
3. An anaesthetist will probably visit you in hospital before the operation to discuss the anesthetic.
4. The hospital provided me with compression stockings (unattractive knee high tight socks to help prevent blood clots developing) and I had to wear these for the operation then 10 days after surgery, 24 hours a day (apart from bathing)!
5. The surgeon will make a small incision in your armpit, whip out the lymph nodes and a small amount of surrounding tissue, fit a temporary drain and that is basically it!

After surgery

1. You will have a drain attached to your armpit.  This is a narrow tube about a metre long which comes out from your armpit and feeds into a bag about the size of child’s pencil case. You can’t feel it because your armpit and surrounding area is numb. The lymph fluid from your arm drains into this bag (it is an orange colour). The lymph drips through the tube; it does not pour through. The drain stays in place until the surgeon is happy that enough fluid has drained out (you have to monitor how much fluid is dripping into the bag). This drain is attached to you all the time (and if you are also having a mastectomy you will probably have more than one drain). You will need to think about how to carry the drain. Some people use a shoulder bag, but you can also buy something called a drain dollie. The breast consultant will remove the drain when he is satisfied with the healing and the amount of fluid draining out. 
2. Your armpit and part of the arm will be numb (some feeling has come back to my armpit although now, 10 months after surgery I still have some numbness).
3.  You will need to ask your breast surgeon when you will be able to drive again following surgery.
4.  You might get a swelling under your arm (the size of a tennis ball in some cases) which is the lymph fluid not knowing what to do with itself after the drain has gone. This is called a seroma and it is important to keep an eye on it to check that it doesn’t show signs of infection (like redness or soreness). Every time my armpit swelled up into one of these seromas, the surgeon aspirated it (extracted the fluid using a needle). This didn’t hurt because the area was totally numb from the surgery. Gradually, the body adjusts and the fluid is absorbed into the surrounding tissue and the swellings stopped.
5.  Use a small soft cushion or pillow under your armpit to give your arm some soft support when the drain is in place, or if you are suffering with a seroma.
6.  If you have cording it is really really really important to do the exercises that you are told to do so that you regain full movement in your arm and to stop you getting a frozen shoulder. I have put a link to a video and a booklet at the end of this section.
7.  Don’t shave your arm pit after you have had the surgery (or ever again) because there is a risk of cutting and infection, and you now need to be extra careful because of the lymphoedema risk. My surgeon recommended a depilatory cream or electric razor rather than shaving or waxing.
8.  If you have any problems or worries about your scar, ask your breast care nurse for advice.

And remember that having had lymph nodes removed you will be at risk of lymphoedema. Please take a look at the lymphoedema section.

HELPFUL RESOURCES AND MORE INFORMATION

Lymph nodes and the lymph system Cancer Research UK.

Lymph node surgery Breast Cancer Care  and Cancer Research UK

A video on exercises to help with cording from Cancer Research UK

The Breast Cancer Care booklet on exercises after surgery can be downloaded or ordered here 

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