Axillary Dissection

What is an axillary dissection?

Axillary dissection is the name of the surgery to remove your lymph nodes in your armpit. This is undertaken when the cancer cells have travelled from the original skin cancer site and settled in the lymph nodes in your armpit.

What are lymph nodes?

Lymph nodes are present throughout the body. The largest numbers of lymph nodes are found in your neck, armpits and groins and are connected by lymph vessels. You may have felt swollen lymph nodes when you have had an infection such as a simple cold. As well as trapping infections, the lymph nodes can also trap cancer cells.

Have I got cancer in my lymph nodes?

When a lump is detected, normally the first step is to have a sample taken. This is called an Ultrasound Guided Core biopsy. This will be performed in the Radiology (X-ray) Department using an ultrasound scan and is sent to the laboratory to be looked at under a microscope. Your doctor may also want you to have a scan prior to surgery.

When will my axillary dissection be carried out?

An axillary dissection is carried out once all the test results are available. You will be admitted to hospital early on the morning of your surgery and should expect to stay in hospital overnight.

Pre-operative assessment

We will ask you some questions in the pre-operative assessment to pick up any significant changes in your health or medication. You may also have a physical examination and/or some medical tests, like blood pressure checks, blood tests to check your organs, skin swabs and ECG (a tracing of your heart). You will also receive a lot of information about your surgical pathway.

Sometimes, the assessment reveals a problem, such as a urinary tract infection (UTI) or high blood pressure, that needs treating before surgery. Should that be the case, your operation is likely to be deferred until the problem has been resolved.

Pre-operative staff will liaise with you and your GP as to the best way of sorting out the issue.

What does the surgery involve?

The operation, which takes about 2-3 hours, is performed under general anaesthetic. All the nodes in that area and some tissue are removed leaving you with a curved scar across your armpit.

What can I expect after the operation?

At the end of the operation, two drains are placed through the skin to drain lymphatic fluid that will collect inside the wound. The drains will be connected to bags that will stay in place until there is minimal drainage; this may be between 4-10 weeks.

You will be shown how to measure and empty the bags before leaving hospital – please see separate leaflet. Some discomfort is to be expected and it is usually worse for the first few days, although it may take a couple of weeks to subside. If necessary, you can take mild painkillers.

You will see a physio on the ward who will give you information on exercises to complete after surgery.

What are the possible complications immediately after surgery?

There are potential problems with any operation. With this type of surgery, complications are rare but you may experience some of the following:

  • Numbness of the skin surrounding the groin
  • Bleeding
  • Collection of fluid around the wound
  • Infection
  • Wound break down
  • Swelling of the leg

If any of these complications occur, please contact your Skin Cancer Clinical Nurse Specialist who will be able to advise you if any treatment is necessary.

What are the possible long-term complications after surgery?

  • A visible scar and hollowing of your groin
  • Numbness of the skin around the operation site
  • Swelling of the leg (lymphoedema)

Lymphoedema

Another risk after surgery is swelling in your leg, called lymphoedema. This happens when your lymphatic system is not doing its job properly. Your lymphatic system is made up of a network of small vessels and groups of lymph nodes which are located throughout the body. As the lymph fluid flows through the nodes, it should collect and filter out unwanted waste products such as bacteria or cancer cells.

Signs of lymphoedema

Lymphoedema can affect you in a variety of ways. If you notice any of the symptoms below, speak to your Skin Cancer
Nurse or GP.

  • Swelling
  • Heaviness of your leg
  • Tightness and stretching of the skin
  • Reduced movement of the joints
  • Thickening and dryness of the skin
  • Discomfort or pins and needles sensation

Can you prevent lymphoedema?

While it is not known exactly what causes lymphoedema an infection or injury to the affected limb may slightly increase your risk of developing lymphoedema.

Therefore looking after your skin is vital:

  • Clean even small cuts and grazes straight away. If there appears to be any sign of infection see your GP straight away.
  • Use a moisturiser daily to keep your skin soft and supple.
  • Take care when cutting nails to avoid breaking the skin.
  • Avoid hot baths and saunas – these may increase swelling.
  • Avoid sunburn by using a SPF30 sunscreen or above and wear loose fitting clothing.
  • Avoid cuts when shaving and use an electric razor.

Exercise

  • Avoid gaining weight and try to lose some if you are already overweight as this may place extra pressure on the lymphatic system.
  • Avoid strenuous exercise – heavy lifting and carrying heavy objects should be avoided.
  • Gentle exercises are advisable but avoid excessive weight lifting. Walking or swimming will keep your joints supple and is important for lymph drainage.
  • Have gentle exercise during long journeys.

References and further Information

Lymphoedema Support Network
www.lymphoedema.org/lsn
Tel: 0207 3514480
NGS Macmillan Wellbeing Centre
Southmead Hospital, Bristol BS10 5NB
Southmead Hospital has a drop-in centre offering a variety of activities/services. For more information telephone 0117 414 7051 or ask your Skin Cancer CNS.

Skin Cancer Research Fund (SCaRF)
Based at Southmead Hospital
Telephone: 0117 414 8755
www.skin-cancer-research-fund.org.uk

Macmillan Cancer Support
Europe’s leading cancer information charity with over 4,500 pages of up-to-date cancer information, practical advice and support for cancer patients, their families and carers.
Telephone: 0808 800 1234
http://www.macmillan.org.uk

CancerHelp
CancerHelp UK is a free information service about cancer and cancer care for people with cancer and their families. Cancerhelp believes that information about cancer should be freely available to all and written in a way that people can easily understand.
www.cancerhelp.org.uk

NHS Constitution: Information on your rights and responsibilities
www.nhs.uk/aboutnhs/constitution


How to contact us:

Specialist Nurse Team:
Lynda Knowles
Joanne Watson
Claire Lanfear
Samantha Wells

NGS Macmillan Wellbeing Centre
Southmead Hospital
Westbury-on-trym
Bristol
BS10 5NB
0117 414 7415
SkinCancerCNS@nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published March 2021. Review due March 2023. NBT002425

Axillary Dissection