Axillary Surgery

What is Axillary Surgery?

Axillary surgery refers to procedures performed on the axilla, also known as the armpit. This area contains critical structures such as nerves, blood vessels, and lymph nodes. Axillary surgery is predominantly performed to assess, diagnose, or treat diseases involving the axillary lymph nodes, which are often related to breast cancer.

Who is Suitable for Axillary Surgery?

Axillary surgery is mainly used in the context of breast cancer management. The suitability for axillary surgery depends on several factors:

Stage of Cancer: Axillary surgery is most commonly indicated for patients who have invasive breast cancer where there is a risk of lymph node involvement. The surgery helps in staging the cancer accurately, which is crucial for determining appropriate treatment options.
Physical Health: Patients need to be in suitable health to undergo surgery, as it involves anaesthesia and potential risks associated with surgical procedures.
Biopsy Results: Sentinel lymph node biopsy is typically considered when the initial biopsy of the breast tumour suggests invasive cancer. If the sentinel lymph nodes are found to be free of cancer, further axillary surgery may not be necessary.
Previous Treatment: Patients who have not undergone any prior axillary surgery or those in whom the status of lymph node involvement is unknown or uncertain might be suitable candidates. Patients who have previously had significant treatment to the axilla (such as extensive surgery or radiation) might not be ideal candidates due to the increased risk of complications.

Benefits of Axillary Surgery

Accurate Staging: One of the primary benefits is the accurate staging of breast cancer. By determining whether cancer cells have spread to the lymph nodes, doctors can better define the cancer stage, which is crucial for deciding on the most effective treatment plan.
Guiding Treatment: The results from axillary surgery can help make informed decisions about further treatment options. For instance, the presence of cancer in the lymph nodes may indicate the need for additional therapies such as chemotherapy, radiation, or hormonal therapy to reduce the risk of recurrence.
Improving Survival Outcomes: By accurately assessing and treating lymph node involvement, axillary surgery improves overall survival rates. It ensures that any metastatic cancer cells in the lymph nodes are removed or adequately treated, thus lowering the chances of cancer spreading further.
Reducing Recurrence: Removing affected lymph nodes can decrease the likelihood of cancer recurrence in the axilla, which is a common site for the initial spread of breast cancer.
Providing Peace of Mind: For many patients, knowing that the cancer has not spread to the lymph nodes or that all affected nodes have been removed can provide significant psychological comfort.

Types of Axillary Surgery

There are mainly two types of axillary surgeries used in the management of breast cancer:

Sentinel Lymph Node Biopsy (SLNB): This procedure involves injecting a tracer material that helps identify the sentinel lymph nodes, the first nodes to which cancer cells are likely to spread from the primary tumour. Only these nodes are removed and tested for cancer cells. SLNB is less invasive and has a lower risk of side effects than more extensive lymph node removal.
Axillary Lymph Node Dissection (ALND): In this more extensive procedure, multiple lymph nodes in the axillary region are removed and examined for cancer cells. ALND is typically performed when cancer has been found in the sentinel lymph nodes or when there is a high clinical suspicion of node involvement without a prior biopsy.

Preparation Before an Axillary Surgery

Medical Evaluation: Undergo a thorough medical evaluation, including blood tests, imaging studies, and a physical examination to assess your health status and fitness for surgery.
Medication Review: Discuss your current medications with your surgeon. Some medications, especially those that affect blood clotting, like aspirin or certain anti-inflammatory drugs, may need to be stopped before surgery.
Preoperative Testing: Depending on your health status, preoperative tests such as chest X-rays, EKG, or specific blood tests may be required.
Fasting: Typically, you'll be instructed to fast (not eat or drink) for several hours before the surgery to prevent anaesthesia-related complications.
Arranging for Help: Plan to have someone drive you home after the surgery and help you out for a few days as you recover.
Preparation at Home: Prepare your home for your return from the hospital by placing frequently used items at an easily accessible height and setting up a comfortable recovery area.

Axillary Surgery Procedure

The specifics of axillary surgery can vary based on the type of procedure being performed:

Sentinel Lymph Node Biopsy (SLNB):
Local anaesthesia, with or without sedation, or general anaesthesia is administered.
A radioactive substance and/or a dye is injected near the tumour site to trace the first draining (sentinel) lymph nodes. These nodes are then surgically removed through a small incision in the axilla.
Typically, it lasts about 30 minutes to an hour.
Axillary Lymph Node Dissection (ALND):
General anaesthesia is usually required.
A larger incision is made in the axilla to remove multiple lymph nodes. This is often done as part of breast cancer surgery, like during a mastectomy or lumpectomy.
The surgery can take 1-2 hours, depending on the extent of the dissection and whether it is combined with other procedures.

Axillary Surgery Recovery Plan

A structured recovery plan is crucial for optimal healing and includes:

Pain Management: Follow your doctor's instructions for taking pain relievers and managing discomfort.
Physical Therapy: Engage in prescribed exercises to restore range of motion and prevent stiffness.
Wound Care: Keep the surgical site clean and dry. Follow your surgeon’s instructions on how to care for the wound and when to remove or change dressings.
Monitoring for Complications: Watch for signs of infection (excessive redness, swelling, warmth, or discharge) or lymphedema (persistent arm swelling).
Follow-up Appointments: Attend all scheduled follow-up visits so that your surgeon can monitor your recovery and address any concerns.

Axillary Surgery Prognosis

If the sentinel lymph nodes are negative for cancer, this generally indicates a better prognosis and may lead to less aggressive treatment approaches.

Positive lymph nodes can indicate a need for comprehensive systemic therapy, which may involve chemotherapy, radiation, or hormonal treatments to manage the disease more aggressively.

Overall, the prognosis after axillary surgery is better when the cancer is detected early and is localised. The procedure itself has a direct impact on tailoring the treatment plan to improve outcomes.

Axillary Surgery Risks

Lymphedema: Perhaps the most significant risk associated with axillary surgery, particularly axillary lymph node dissection. It involves swelling of the arm caused by lymph fluid buildup after lymph nodes are removed.
Infection: Any surgery carries a risk of infection at the incision site.
Nerve Damage: There is a risk of nerve damage during the surgery, leading to numbness, pain, or weakness in the arm, shoulder, or chest.
Seroma: The formation of fluid-filled pockets at the surgery site may need to be drained.
Limited Range of Motion: Temporary or permanent limitation in the shoulder or arm movement on the affected side.
Pain: Chronic pain can occur in some patients following axillary surgery.

What if Axillary Surgery is Delayed?

Delaying axillary surgery increases the risk of cancer spreading to more lymph nodes or beyond, which can complicate treatment and potentially worsen the prognosis. Delays can also increase psychological stress for the patient, affecting their overall well-being and possibly their decision-making regarding treatment. A delay might limit the available treatment options. For example, if the cancer spreads during the delay, more extensive surgery or additional systemic therapy might become necessary.

Therefore, timely intervention with axillary surgery, when indicated, is crucial for optimal management, particularly in cases of invasive breast cancer where lymph node status significantly influences treatment planning and outcomes.