Axillary lymph node dissection
Axillary lymph node dissection (ALND), sometimes called axillary clearance, is an operation to remove the tissue in the armpit which contains most of the lymph nodes draining the breast. This surgery is usually done when cancer has spread to the armpit lymp glands to check how much cancer is there and remove it.
Typically 8-24 lymph glands are removed, but the precise number can be very variable. ALND is usually done at the same time as breast surgery but can be performed later.
Key points
  • Operation to remove all the arm pit tissue with lymph glands
  • May be at the same time as breast surgery or later
  • More invasive than SNB
  • Risk of lymphoedema
Alternatives

Sentinel lymph node biopsy is often performed to look for cancer in the armpit. If cancer is found before surgery, ALND is usually advised.

Some cancer in the armpit can be treated with radiotherapy instead of surgery. Your cancer care team will discuss this with you if needed.


Potential problems
  • Bleeding, including a pocket of blood under the skin (haematoma) (1%)
  • Wound infection (<5%)
  • Lymphoedema (25%)
  • Nerve damage - pain or numbness
  • Breast cancer recurrence (1% per year)
  • Blood clots (DVT/PE)
  • Risk of anaesthesia (low)
Associated treatment
Most women having ALND also have breast surgery. This may be at the same time, or may have already happened previously. 

Many women with breast cancer are recommended to take hormonal therapy for several years. This depends on the biology of your cancer and will be discussed with you in detail if needed.

Most women needing ALND will also be recommend radiotherapy. This will be discussed in detail with your radiation oncologist.

Some women are recommended to have chemotherapy or targeted therapy for several months. Again this depends on the biology of your tumour and you will discuss this in detail with your medical oncologist if needed.

On the day of surgery
You will need to fast for 6 hours before surgery. You can take any medications as normal and continue to drink water until 2 hours before surgery.
You should shower and wash well in the morning. Bring something to do as there will be a lot of waiting.
When you arrive you will be checked in by the nurses and change into a gown and stockings ready for the operation.
In the holding bay
You will see your surgeon and anaesthetist, have a drip put in and have the operative site marked. You might also be given premedication.
In recovery
After surgery you will go to recovery. You will be watched closely until you are alert and well enough to return to the ward. You might be given medication for any sickness or pain.
After surgery
Swelling or bruising is common and usually settles on its own. 
You will probably have a drain (plastic tube) to prevent fluid building up in the wound. This is usually removed after about a week. You can shower carefully straight away. Try not to soak your dressings and pat them dry afterwards.
Pain and discomfort can usually be managed with simple painkiller tablets.
Eat healthily and try to exercise a little every day. You will probably find your movement restricted for several weeks. The exercises given to you by your breast care nurse will help to minimise stiffness.
If you have any concerns call the team - we would rather know about it and you are never wasting our time! We can always arrange for you to come to the clinic if needed and if you are unwell out of hours you can always attend the emergency department.
Driving
You need to be able to concentrate properly and perform an emergency stop without any distracting pain. You will probably need to avoid driving for 1-2 weeks, but check with your insurance company.
Work
Getting back to work can be necessary or helpful for many women, but you will probably need to wait at least until you get your results and can plan any further surgery or treatment. 
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