Lymph Node Dissection

What are lymph nodes?

Our bodies have a network of nodes and vessels that carry a clear fluid called lymph throughout our bodies. This process is similar to the way blood vessels carry blood to all parts of our body. The lymph fluid contains white blood cells, which help us fight infections. Cancer cells can travel through the lymph system, and because the lymph system runs throughout the body, these cancer cells can spread to other areas of the body.

Lymph nodes are found in different parts of the body:

• Axillary nodes are under and around the armpit.  

• Inguinal nodes are in the groin.

• Cervical nodes are in the head and neck area.

  

What is a lymph node dissection?

This is a surgery done to remove lymph nodes. Lymph nodes may need to be removed if cancer is suspected or found in them. 

Lymph node dissection can either be done by itself or it can be done at the same time you have surgery to remove any cancer. 

Risks with Surgery

Removal of lymph nodes can change the way the lymph fluid flows through that side of your body. Excess fluid can build up and cause lymphedema (swelling). 

Swelling of the limb or neck may be slight. It may cause the skin in that area to feel tight. If it is severe, it can cause your entire limb or neck to be very swollen. The swelling may appear months to years after surgery. The chance that you will get lymphedema depends on where in the body the lymph nodes are removed. If you get other types of treatment, such as radiation, you may be more likely to develop swelling or lymphedema. You may not notice swelling on a day to day basis. This varies. It is hard to predict if someone will develop lymphedema. The reported risk ranges from 2-40%.

Right after surgery, it is normal to have some swelling in the affected area on the side of the surgery. This swelling is most often short-term. If you have swelling, your doctor will watch it. They may also want to you see an occupational or physical therapist. 

Planning for Lymph Node Surgery 

After a lymph node dissection, you should plan to stay in the hospital for 1-2 nights. You may go home sooner if your surgeon feels you are ready.

You should plan to be off from work for at least 1-2 weeks. This will vary based on the type of lymph node surgery and the type of work you do. Your activity after a lymph node surgery may be limited. For example, you may need to avoid lifting objects that weight more than 10 pounds with your involved arm. We suggest you keep your leg raised when possible after an inguinal lymph node dissection. You will get more detailed instructions before you leave the hospital. 

You may have a home health nurse visit you after surgery. This can be set up before your surgery. You may also have a friend or family member help you with your care. Please tell your doctor if you will need a home health visit after surgery.

At the Hospital

If you have a paravertebral block, you will get medicine through your IV to put you to sleep. 

If you have general anesthesia, you get medicine that puts you into a very deep sleep. A tube is then placed into your trachea (windpipe) to help you breathe. With either of these options, you will not know what is happening or feel any pain.

When you return to your hospital room, you will have: 

• An incision covered with gauze, a clear bandage, or “sterile super glue”. 

• 1 or more drainage tubes in place. 

• An IV line. 

• Special leg pumps on. These help to keep good blood flow to your legs. The goal is to prevent blood clots until you are up and walking.

• Nurses will ask you to rate your pain and give you medicine to help keep you comfortable. 

• Your vital signs checked.

• You can have family or friends visit.

Care After Surgery

You can go home once you can eat, drink, and your pain is controlled. You are given pain medicine when you go home. Someone must drive you home. Your surgeon should call you in about 1 week with the results of your surgery. 

If you have drains placed, see Health Facts for You #4603, “Drain Care at Home.” This will help you care for them. We want to make sure your incisions heal. 

You will have a follow-up visit with your doctor. You may also see a lymphedema therapist during this first visit.

Care of Your Incision

Check the site daily for any problems or signs of infection. You may see a slight redness and swelling along your incision or there may be a small amount of pink drainage coming from your incision. This is normal.  

Place a new gauze over your incision. If you have Steri-Strips (small strips of tape) in place, they may fall off by themselves in about 1 week. They can also be removed in clinic. If you had “sterile super glue” on your incision, no dressing is needed. 

Your doctor will tell you if you can shower after surgery. When you shower, let the water flow over the incision(s). Pat dry. Safety pin the drains to a robe tie or lanyard while in the shower. This keeps the drains in place and keeps them from dangling.

What is a seroma and how do I know if I have one?

A seroma is a fluid-filled bulge that forms under the skin in the area of surgery. You may hear a “sloshing” sound in the breast when they move. This is fluid filling the surgical area. If you develop a small seroma, your body will slowly absorb this over time. If you have a seroma that gets larger and causes pain, please contact your doctor. This is not an emergency. You may be asked to go back to the clinic to have the fluid drained.

What to Know About Pain and Narcotics

The amount of pain you have after surgery varies. You will get a prescription for a narcotic pain medicine. 

• Use them as needed and as ordered. 

• Do not drive while taking narcotics. 

• If you have nausea, take your pain medicine with food.

• Narcotics can cause constipation.

  • Eat plenty of fiber (bran, oats, fruits and vegetables).

  • Drink 6-8 glasses of water a day.

  • Take stool softeners if needed.

Most women find that 1–2 tablets of Extra-Strength Tylenol® every 4-6 hours helps to relieve pain. You may take up to a total of 8 tablets in a 24-hour period. Do not take more. If you have liver disease, check with your doctor first. You may also take ibuprofen as directed by your doctor. Talk to your doctor if you take other pain medicine.

When to Call 

Please call us if you have:

• Increased swelling at the site of surgery

• Firmness or bruising

• Heavy bleeding

• An opening in the incision

• Sudden increase in pain

• Increased drainage from your site or drainage bulb(s) that fill quickly with the need to empty them every 1-2 hours

• Signs of a seroma 

• Fever of 100.4°F (38°C) or greater taken by mouth 2 times, 4 hours apart

• Increased tenderness, redness, warmth, or swelling of the incision or drain sites. A small area of redness about the size of a dime is common by the stitch around the drain

Call your doctor or nurse if you have these problems with lymphedema:

• Your arm/leg/neck remains swollen and painful for many days. 

• You have any sign of infection in your arm/leg/neck (swelling, pain, redness, increased warmth, or fever). 

• Your arm/leg/neck feels heavy and tight. 

• The skin in your arm/leg/neck feels hard. 

• Your joints in the arm or leg are stiff. 

• You have hardening or your skin changes color on your involved arm/leg/neck.

How to Lower Your Risk of Lymphedema

You may or may not develop lymphedema after a lymph node surgery. Here are some things you can do to help avoid lymphedema or to keep it stable. 

Skin Care

• Keep your arm or leg clean and dry.

• Clean, protect, and watch minor cuts on or near the affected area. 

• Use an over-the-counter antibacterial cream on any openings once they are cleaned. 

• Cover cuts with a bandage if needed. 

• Avoid insect bites, animal scratches, cuts, or punctures of the skin. This includes IVs and/or blood draws.

• Use insect repellent when outdoors to avoid bug bites. If you get stung by a bee, clean and elevate your arm or leg and apply ice.

• Use lotion to prevent cracked skin. Germs can enter through cracked skin. 

• Be careful when you cut your nails. Do not cut your cuticles. 

• Do not have blood pressures taken or blood drawn from the affected arm.

• If inguinal lymph nodes were removed, try to prevent athlete’s foot. Dry the area between the toes thoroughly after washing. Wear cotton socks to absorb sweat. Change socks if they become wet. Let shoes air out. Use fungal powders or creams as needed. 

• Avoid tight jewelry and clothing. 

• Wear gloves when you garden, use strong cleaning products or clean up after pets.

• Some people are sensitive to temperature extremes. Watch your affected limb when using hot tubs or saunas. Avoid these if swelling increases.

Activity

If you have lymphedema, regular exercise may help. Slowly build up your strength and the amount of time that you use the affected limb. Maintain optimal weight. Weight gain can be a risk factor for lymphedema. Avoid shoulder bags on the affected arm, standing for long periods, sitting or crossing legs if you had an inguinal lymph node dissection.  

Important Phone Numbers

To reach your doctor, Monday – Friday, 8:00 am to 5:00 pm:

• UW Health Breast Center at UW Hospital (608) 266-6400 or toll-free 1-800-323-8942

• UW Health Surgery Clinic at 1 South Park St. (608) 287-2100 or toll-free 1-888-703-2778

• UW Health General Surgery Center at UWHC (608) 263-7502

For Emergencies

• UW Hospital Emergency Room (608) 262-2398

• Meriter Hospital Emergency Room (608) 417-6206

• Your local Emergency Room

After Hours

• UW Health Breast Center at UW Hospital – Call (608) 262-0486 and ask for the surgery resident on call. Give your name and phone number with the area code. The doctor will call you back.

• UW Health Surgery Clinic at 1 South Park St. – Call (608) 287-2100 and ask for the doctor on call. Give your name and phone number with the area code. The doctor will call you back.