Axillary Lymph Node Dissection Hyderabad

What axillary dissection involves

Axillary lymph node dissection (ALND) removes the lymph nodes in levels I and II of the axilla, the region of the armpit. Level I nodes sit below and beside the pectoralis minor muscle. Level II nodes lie behind it. Together, these are the primary drainage nodes for the breast. Removing them tells your oncology team how far the cancer has spread and allows for local disease control in the armpit.

Most ALND procedures remove between ten and twenty lymph nodes, though this varies. The nodes are sent to the pathology laboratory where they are examined for cancer involvement.

When axillary dissection is recommended

ALND is recommended when there is confirmed cancer in the axillary lymph nodes. The main situations include:

Sentinel lymph node biopsy shows cancer in one or more nodes and ALND is clinically indicated
Lymph nodes are clinically palpable (felt on examination) and confirmed positive on biopsy before surgery
Four or more positive sentinel nodes are found
Specific tumour types or stages where axillary clearance is part of the standard treatment plan

Difference from sentinel lymph node biopsy

Sentinel lymph node biopsy (SLNB) identifies and removes only the first one to three lymph nodes that drain the breast tumour. If those nodes are clear of cancer, the remaining nodes are left alone. ALND goes further and removes many more nodes from the armpit.

SLNB is the preferred first step for patients with no known node involvement. ALND is used when nodes are confirmed positive, or when the results of SLNB indicate that the axilla needs to be cleared.

What happens during surgery

ALND is performed under general anaesthesia and usually takes about one hour. It is most often done at the same time as mastectomy or lumpectomy, through the same or an adjacent incision. The surgeon carefully dissects the axillary contents, preserving important structures including the thoracodorsal nerve and vessels, the long thoracic nerve, and the axillary vein.

A drain is placed in the axilla at the end of the operation to collect fluid that accumulates as the area heals.

Recovery

Hospital stay is typically two to three days when ALND is combined with mastectomy, or one to two days when done alongside lumpectomy. The drain stays in for one to two weeks and is managed at home. You will be taught how to empty and record the drain output before discharge.

Arm exercises begin the day after surgery. These are important. Starting early reduces the risk of stiffness, cording (axillary web syndrome), and shoulder problems. Most patients regain good arm movement within four to six weeks.

Lymphoedema risk and prevention

Lymphoedema is persistent swelling of the arm on the side where lymph nodes were removed. It is a permanent but manageable risk after ALND. The risk is around 15 to 25 percent over a lifetime and is higher if radiotherapy to the axilla is also given.

The risk can be reduced. Avoid blood pressure cuffs, injections, and blood draws in that arm. Protect the arm from cuts and infections. Wear compression if you notice swelling during travel or exertion. A lymphoedema physiotherapist can provide a tailored programme. Early intervention when symptoms start gives the best outcomes.

Lymphoedema does not affect everyone who has ALND. Many patients never develop it. Knowing the risk and taking simple precautions from the start is the best approach.

Frequently asked questions

Can I avoid ALND if only one sentinel node is positive?

Sometimes yes. For patients with early breast cancer, one or two positive sentinel nodes, and who are having a lumpectomy followed by whole-breast radiotherapy, several large clinical trials have shown that ALND can safely be omitted without affecting survival. This is not universal and depends on tumour size, grade, and other factors. Dr. Shruthi will review your individual situation and explain whether omitting ALND is appropriate for you.

Will I lose the use of my arm after ALND?

No. ALND does not cause loss of arm function. Some patients experience temporary stiffness, tightness, or a pulling sensation when lifting the arm in the first few weeks. This resolves with physiotherapy exercises. Numbness along the inner upper arm is common and can persist, as a small sensory nerve in this area is often cut during dissection. Most patients return to full arm use within six weeks.

How many lymph nodes are typically removed in ALND?

Standard ALND removes level I and II lymph nodes, which typically numbers between ten and twenty nodes. The exact number varies by anatomy. A minimum of ten nodes is generally considered adequate for staging. If there is obvious disease in level III nodes (above the pectoralis minor muscle), the dissection may be extended, but this is less common.

Axillary lymph node dissection