Reviewed March 2007

A Guide for Women

This guide is for women who experience axillary dissection as part of the management of breast cancer. Developed by the Breast Tumour Group at the B.C. Cancer Agency, this guide can help you and your health care provider plan for your rehabilitation following axillary surgery.

What is axillary dissection? The "axilla" is a medical term for the underarm area or armpit which has, in it, about 30 –60 lymph nodes. To determine whether breast cancer has spread to these lymph nodes, most women with breast cancer will have some lymph nodes (usually 10 –15) removed from their axilla by their surgeon. After the nodes are removed, the surgeon usually leaves a drain in the axilla for about a week to drain excess lymph fluid. The presence or absence of cancer cells within the lymph nodes is an important predictor of whether the cancer will recur elsewhere in the body and determines whether or not you need chemotherapy or radiation.

What is upper extremity rehabilitation? The "upper extremity" refers to the shoulder, arm, forearm, wrist, and hand. The surgeon must cut around and through skin, fat, muscles, and nerves to get to the axillary lymph nodes. This can lead to stiffness and loss of motion in the shoulder as well as lack of sensation on the inside surface of the upper arm. Rehabilitation, frequently under the direction of a physical therapist, can help to restore full movement of your shoulder and can minimize the shoulder stiffness that often follows axillary dissection.

What should I know about my upper extremity before surgery? You should know whether the size, strength, active range of motion (full movement) and sensation (or feeling) in both your arms are identical. Your doctor or a physical therapist can provide these baseline measurements for you. The size or circumference of your arms should be measured with a tape measure at the knuckles, wrist, 10 cm. below and 15 cm. above your elbow (lateral epicondyle).

What should I know about my upper extremity after surgery? Each of the measurements that was taken before surgery (range of motion, strength, sensation, and arm circumference) should be taken again in the weeks following surgery by either your doctor or a physical therapist. You can expect to have some loss of shoulder motion and strength in the affected arm and loss of feeling on the inside surface of the upper arm.

When the surgeon removes lymph nodes from the axilla, the lymphatic system in your underarm is disrupted, leaving you at risk for lymphedema as discussed below. Scarred lymphatic vessels which are thin, cord-like structures that look a bit like violin strings may also appear underneath the skin of your arm. Cording usually develops within a few weeks after surgery. These structures, although alarming, are essentially harmless and will disappear or actually "snap" on their own as you do your stretching exercises.

What types of exercises are worth doing after axillary dissection? Even before the axillary drain has been removed, you can begin gentle movements of your shoulder. Once the axillary drain is out, it is important to start working on regaining full shoulder motion.