Dennis R. Holmes, M.D., F.A.C.S., is an internationally renowned breast cancer expert with locations in Santa Monica, Glendale, and Los Angeles, California. He is one of very few surgeons in the U.S. performing lymph node-sparing surgery, specialized techniques to minimize the side effects of lymph node surgery.
Removal or injury to lymph nodes and lymph vessels in the armpit may cause lymphedema or chronic arm swelling in up to 10-30% of women undergoing axillary node dissection (removal of most of the underarm lymph nodes) and about 5% of women undergoing sentinel node biopsy (typically removal of 1-3 lymph nodes). Lymphedema is swelling of the hand, forearm, and/or arm resulting from blockage of water drainage from the arm.
Under usual circumstances, the surgeon is unable to distinguish lymph nodes/vessel that drain the breast from those that drain the arm 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 utilizes a blue dye injected into the arm which turns the arm lymph nodes blue. This makes them visible which allows them to be avoided by the surgeon.
Lymph node-sparing surgery can be performed whenever lymph node surgery is needed for management of breast cancer. In its 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 for sparing lymph nodes is to offer women with positive lymph nodes chemotherapy prior to surgery with the goal of clearing away cancer within the nodes. If positive nodes can be converted to normal or negative lymph nodes with the use of chemotherapy, then Dr. Holmes can reduce the number of lymph nodes that must be removed at the time of lymph node surgery. On the other hand, there are cases in which a lymph node draining the arm must be removed, which increases the risk of lymphedema. In such cases, Dr. Holmes can perform lymphatico-venous anastomosis to connect the lymphatic vessels draining the arm to a nearby vein to maintain arm lymphatic drainage.
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 with the use of compression garments, specialized exercises, and massage. You may also be referred to a surgeon who specialized in restoring lymphatic drainage utilizing microsurgical procedures. However, 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 potentially a candidate for lymph node-sparing surgery. However, the women that benefit most from lymph node-sparing surgery are women with positive lymph nodes.
"He treated my daughter who had stage one breast cancer. He put us at ease and calmed our fears , he was the perfect surgeon for our situation."
"He has to be one of the most incredible doctor that I've been blessed to have on my survival team. He's saved my life! I'm a proud 28 yr B C survivor."
"Dr. Holmes is kind, professional, and has a lot of patience answering every question you might have."
"Great and SMART staff. Great place with ZERO infection rate. I was back to work after surgery way sooner then expected! Awesome place great center."
