Lumpectomy and Axillary Lymph Node Dissection

What is a lumpectomy and axillary lymph node dissection?

A lumpectomy is a surgical procedure for removal of a cancerous lump from a woman's breast. Axillary lymph node dissection is removal of the lymph nodes under the armpit. These procedures are treatment for breast cancer.

When is it used?

This procedure is a treatment option when a lump has been found in your breast and a biopsy has shown it is cancerous.

As an alternative you could:

Have a sentinel node biopsy rather than an axillary node dissection with the lumpectomy. A sentinel node biopsy is done by injecting a special dye around the cancer and then removing only the lymph nodes affected by the dye (usually 1 to 3 nodes). These nodes are examined for cancer. If cancer is found in these nodes, then an axillary node dissection can be done later.
Have the entire breast and lymph nodes removed (a mastectomy).
Try chemotherapy or radiation therapy or have a combination of the therapies. (Usually these treatments are started after the cancerous lump has been removed. Chemotherapy may be started before surgery to shrink a large tumor to allow a lumpectomy instead of mastectomy.)

You should ask your health care provider about these choices.

How do I prepare for a lumpectomy?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your health care provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general anesthetic. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

The surgeon makes a small cut and removes the lump and surrounding breast tissue. If axillary node dissection is planned, the lymph nodes under your armpit are removed through another cut in the armpit.

If you and your surgeon have chosen sentinel lymph node biopsy, a special dye is injected around the cancer just before removal. Then a smaller incision is made in the armpit and the 1 to 3 nodes containing the dye are removed. You will be told a few days later whether cancer was found in the nodes. If cancer was found, you will need another procedure to remove the remaining lymph nodes (axillary lymph node dissection). Fortunately, most women can avoid full axillary node dissection with this method.

The cut(s) will be closed with stitches. If you have a full axillary node dissection, a drain will be left in the cut in your armpit for a few days.

What happens after the procedure?

You may go home that day or stay in the hospital overnight. Your health care provider may suggest you start treatment with radiation or chemotherapy, depending on the lab tests and findings in the final pathology report. It is helpful to have a family member or friend with you on the first visit after surgery when you discuss the final pathology report.

Ask your health care provider what other steps you should take and when you should come back for a checkup. If you have an axillary lymph node dissection, your surgeon will give detailed instructions on how to care for the drain under your arm and when to return for drain removal. Be sure you understand when to return to discuss the final pathology report from your surgery.

What are the benefits of this procedure?

You may have the cancer removed without losing your breast.

What are the risks associated with this procedure?

There are some risks when you have general anesthesia. Discuss these risks with your health care provider.
You may have infection or bleeding.
A lumpy scar, called a keloid, might form after the surgery.
The underside of your arm will probably be numb after axillary lymph node dissection due to the loss of nerves to the skin. The extent of numbness varies from person to person.
Depending on the size of the lump that was taken out and the size of your breast, the shape of your breast may change.
Your nipple may point another way and your breasts may not match as well as before the surgery.
The final pathology report may reveal that the cancer was not completely removed. If this happens, you will need more surgery.
The cancer may recur, although radiation therapy can reduce the risk of recurrence.

You should ask your health care provider how these risks apply to you.

When should I call my health care provider?

Call your provider right away if:

You develop a fever.
You have problems with the drain.
You have bleeding or weeping from the wound.
You have a lot of pain. (You should not have much pain and it should get better, not worse.)

Call during office hours if:

You have questions about the procedure or its result.
You want to make another appointment.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File SRG5013F.HTM Release 9.0/2006