About Your Axillary Surgery

Axillary lymph node dissection

An axillary lymph node dissection is when most or all of the lymph nodes in your armpit are removed. The number of lymph nodes removed varies from person to person.

About your lymphatic system

It can be helpful to understand how your lymphatic system works if you’re having an axillary node dissection. Your lymphatic system has 2 jobs:

• It helps fight infection.

• It helps drain fluid from areas of your body.

Your lymphatic system is made up of lymph nodes, lymphatic vessels, and lymphatic fluid (see Figure 1).

• Lymph nodes are small bean-shaped glands located along your lymphatic vessels. Your lymph nodes filter your lymphatic fluid, taking out bacteria, viruses, cancer cells, and other waste products.

• Lymphatic vessels are tiny tubes, like your blood vessels, that carry fluid to and from your lymph nodes.

• Lymphatic fluid is the clear fluid that travels though your lymphatic system. It carries cells that help fight infections and other diseases.

Recovering after your surgery

This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery at home. As you read this section, write down questions to ask your healthcare provider.

Tubes and drains

If you had an axillary lymph node dissection, you’ll have a soft catheter (flexible tube) called a Jackson-Pratt (JP) drain inserted near the incision in your armpit. It will drain extra fluid from the area and will still be in place when you’re discharged from the hospital. Your nurse will give you information to help you take care of it at home. You will be contacted to remove the drain when it has been more than three weeks since surgery or it has less than 30mL (30cc) of fluid per day x 2 days.

At home

Caring for your incision(s)

Look at your incision(s) every day. Call your healthcare provider if you see any redness or drainage.

Your incision(s) will be closed with sutures under your skin. These sutures dissolve on their own and don’t need to be removed.

You will have Steri-Strips on your incision(s), they’ll usually loosen and fall or peel off on their own. If they haven’t fallen off after 14 days, you can take them off.

A week or two after your surgery, a pocket of fluid may form under the skin of your armpit where tissue was removed. This is called a seroma, and it’s harmless. The area may feel soft and puffy. It may also feel tender.

Seromas often go away on their own. If you develop a seroma that’s large or feels uncomfortable, call your healthcare provider’s office to discuss with your doctor or nurse. Seromas can be drained if they are causing you pain or discomfort.

New sensations (feelings) in your arm or shoulder

As you’re healing, you may feel a few different sensations in your arm or shoulder area. Tenderness, numbness, and twinges are common examples.

These sensations usually come and go and will lessen over time, usually within the first few months after surgery. However, some may last months, even 5 years or longer. This is because your nerves are the slowest part of your body to heal. Most people tell us the sensations aren’t severe or distressing.

As you continue to heal, you may feel scar tissue along your incision site(s). It will feel hard. This is common and will soften over the next several months.

Showering

You can shower 24 hours after your surgery. Taking a warm shower is relaxing and can help decrease discomfort.

When you’re ready to shower, take off any gauze pads covering your incision(s). Don’t remove the Steri-Strips. Gently wash your incision(s) with soap and water, letting the shower water run over them. Pat the areas dry with a clean towel.

You can leave your incision(s) uncovered, unless you have drainage. If you have drainage, call your healthcare provider. If it feels more comfortable, you can place a clean gauze pad over your incision(s).

Don’t take tub baths, swim, or use hot tubs or saunas for 4 weeks. Don’t use deodorant, lotion, powder, or perfume anywhere near your surgery site for 4 weeks.

Managing your pain

People pain or discomfort for different lengths of time.

Follow these guidelines to help manage your pain at home.

• Take your medicines as directed and as needed.

• Call your healthcare provider if the medicine prescribed for you does not help your pain.

• Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.

• You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.

• Follow your healthcare provider’s instructions for stopping your prescription pain medicine.

• Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider.

• Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver. Do not take more than one medicine that has acetaminophen without talking with a member of your care team.

• Pain medicine should help you get back to your usual activities. Take enough to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.

• Keep track of when you take your pain medicine. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medications (such as opioids and Tyelnol #3) may cause constipation (having fewer bowel movements than usual).

Preventing and managing constipation

You can also follow the guidelines below to prevent and manage constipation.

• Go to the bathroom at the same time every day. Your body will get used to going at that time. If you feel the urge to go, though, don’t put it off.

• Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.

• Exercise, if you can. Walking is an excellent form of exercise.

• Drink 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Choose liquids such as water, juices (such as prune juice), soups, and ice cream shakes. Avoid liquids with caffeine (such as coffee and soda). Caffeine can pull fluid out of your body.

• Slowly increase the fiber in your diet to 25 to 35 grams per day. Fruits, vegetables, whole grains, and cereals contain fiber.

• Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:

• Docusate sodium (Colace®). This is a stool softener (medication that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Don’t take it with mineral oil.

• Polyethylene glycol (RestoraLAX®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.

• Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.

If any of these medications cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if needed.

Physical activity and exercise

You can start doing most activities again right away, but it’s best to pace yourself as you return to your daily routine. You can start more strenuous exercise 4 weeks after surgery (such as running, jogging, or lifting weights). Read Exercises After Your Axillary Lymph Node Procedure. It has exercises that you can do to help you regain motion in your arm and shoulder.

Driving

You can start driving again as long as you aren’t taking prescription pain medication that may make you drowsy. You should also have full range of motion of your arm and be able to comfortably turn the steering wheel.

About lymphedema

Sometimes, removing lymph nodes can make it hard for your lymphatic system to drain properly. If this happens, lymphatic fluid can build up in the area where the lymph nodes were removed. This extra fluid causes swelling called lymphedema.

Lymphedema can develop in the arm, hand, breast, or torso on your affected side (the side where your lymph nodes were removed).

Most people don’t develop lymphedema, but some do. It’s hard to know a person’s risk of developing lymphedema because:

• There’s no standard test for diagnosing lymphedema.

• Removing or injuring lymph nodes affects people differently.

• Lymphedema can develop soon after surgery, or it can develop years later.

• Current cases of lymphedema can be caused by older treatment methods.

During an axillary lymph node dissection, the lymph nodes are removed from your armpit. This is done to remove lymph nodes that may have cancer cells. About 15 to 25 out of every 100 people who have an axillary lymph node dissection may develop lymphedema. There’s no way to know for sure who will develop lymphedema.

Lowering your risk of developing lymphedema

Doing the following things may help lower your risk of developing lymphedema.

• Stay at or safely work towards a healthy body weight.

• Exercise and stretch your muscles regularly. Start with the exercises that are listed in the handout Exercises After Your Axillary Lymph Node Procedure.

• When you resume exercise and activity, make sure to build up slowly and gradually. If you feel discomfort, stop and take a break. Exercise shouldn’t cause pain.

• Try to minimize your risk of infection to your hand and arm.

• Read the resource Hand and Arm Guidelines After Your Axillary Lymph Node Dissection for information about lowering your lymphedema risk after your procedure.

Signs of lymphedema

Some mild swelling after surgery is normal. The swelling may last for up to 6 weeks. It’s often temporary and will gradually go away. You may also feel pain or other sensations, such as twinges and tingling, after surgery. These feelings are common and aren’t necessarily signs of lymphedema.

If you’re at risk of developing lymphedema, watch for these signs in your affected arm, hand, breast, and torso:

• A feeling of heaviness, aching, or pain.

• A tight feeling in your skin.

• Less flexibility.

• Skin changes, such as tightness or pitting (skin that stays indented after pressing on it).

If you have any signs of lymphedema or aren’t sure, contact your healthcare provider.

Sexual activity

You can start sexual activity when you feel ready. It won’t harm your surgical area. Avoid putting pressure on the surgical site in the first weeks after surgery. Try placing a small pillow or towel over the surgical area. If you have any questions, talk to your nurse.

It may be helpful to let your partner see your incision(s) soon after surgery. This may ease any anxiety you both may feel. Your partner might worry that touching your incision(s) will hurt you. Let them know what is and isn’t comfortable.

Follow-up appointments

Your follow-up appointment will be 3-4 weeks after your surgery. Your healthcare provider will talk with you about your pathology results during this appointment.

Managing your feelings

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to help you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

When to call your healthcare provider

Call your healthcare provider if:

• You have a fever above 101 °F (38.3 °C).

• You have shortness of breath.

• The skin around your incision is warmer than usual.

• You have more discomfort in the area.

• The area around your incision is getting redder.

• The area around your incision is starting to swell.

• Swelling around your incision is getting worse.

• There’s discharge coming from your incision.