Removal or injury to arm lymph nodes and lymph vessels that originate from the arm may cause lymphedema or chronic arm swelling. Under normal circumstances, a surgeon is unable to distinguish arm lymph nodes/vessel from breast lymph nodes/vessels, because they look the same and are located in the same area of the armpit. Lymph node-sparing surgery using the axillary reverse mapping technique utilized a blue dye injected into the arm which turns the arm lymph nodes blue. This makes them visible to capable of being distinguished for arm lymph nodes/vessels.
Lymph node-sparing surgery can be performed whenever lymph node surgery is needed for management of breast cancer. In it simplest form, lymph node sparing surgery can be performed using axillary reverse mapping at the time of sentinel node biopsy or axillary node dissection to identify arm lymph nodes and lymph vessels which may be avoided or spared. Another strategy of sparing lymph node is to offer women with positive lymph nodes chemotherapy with the goal of clearing away cancer within the nodes. If positive nodes can be converted to normal or negative lymph nodes, then Dr. Holmes can reduce the number of lymph nodes that must be removed at the time of lymph node surgery.
Lymphedema or chronic arm swelling occurs in approximately 5% women undergoing sentinel node biopsy and 15-30% of women undergoing axillary node dissection, depending on whether or not radiation is also needed. Lymphedema is treatable, but not usually curable. The best solution is prevention by limiting the number of lymph node removed and avoiding removal or disruption of lymph node and vessels that drain the arm.
Anyone undergoing lymph node surgery is a candidate for lymph node-sparing surgery.