Welcome to Lahore Oncoplastic Breast Services. I’m Dr. Hammad Raza Sheikh, and today I’d like to talk to you about a crucial procedure in breast cancer treatment: axillary node dissection. This procedure plays a vital role in both diagnosing and treating breast cancer, and I want to help you understand its importance, recent advancements, and what you can expect if you need this surgery.

Understanding Axillary Node Dissection

Axillary node dissection (AND) is a surgical procedure where lymph nodes in the armpit (axilla) are removed and examined to check if cancer has spread beyond the breast. This procedure is essential for several reasons:

1. Staging: It helps determine the extent of cancer spread, which is crucial for treatment planning.
2. Prognosis: The number of affected lymph nodes can indicate the likelihood of cancer recurrence.
3. Treatment guidance: Results from AND can influence decisions about additional treatments like chemotherapy or radiation.

Recent Advancements in Axillary Node Dissection

The field of breast cancer surgery has seen significant advancements in recent years, many of which have improved the axillary node dissection procedure. Here are some key developments:

1. Sentinel Lymph Node Biopsy (SLNB): This less invasive technique allows us to identify and remove only the first few lymph nodes where cancer is likely to spread. If these nodes are cancer-free, a full axillary dissection may be avoided.
2. Axillary Reverse Mapping (ARM): This technique helps identify and preserve lymph nodes and vessels that drain the arm, potentially reducing the risk of lymphedema.
3. Targeted Axillary Dissection (TAD): This combines SLNB with removal of specific lymph nodes that showed cancer involvement on initial biopsy, allowing for more precise surgery.
4. Intraoperative Assessment: Techniques like frozen section analysis allow for real-time evaluation of lymph nodes during surgery, potentially avoiding a second operation.

In Pakistan, we’re working hard to implement these advanced techniques. At Lahore Oncoplastic Breast Services, we’re proud to offer SLNB and are in the process of introducing ARM and TAD to provide our patients with the most up-to-date care.

Axillary Node Dissection in Pakistan: Statistics and Trends

While comprehensive national data on axillary node dissection in Pakistan is limited, our clinic data and regional studies provide some insights:

– Approximately 70% of breast cancer patients in urban centers like Lahore undergo some form of axillary surgery.

– Of these, about 40% require a full axillary node dissection, while 60% are candidates for SLNB.

– The average age of patients undergoing AND at our clinic is 48 years.

– The most common reason for AND is invasive breast cancer (85% of cases).

A study conducted at Shaukat Khanum Memorial Cancer Hospital in Lahore found that the adoption of SLNB reduced the need for full axillary dissection by 35% in early-stage breast cancer patients.

Traditional vs. Advanced Techniques: A Comparison

Traditional axillary node dissection involved removing most or all of the lymph nodes in the axilla. While effective for staging and local control, this approach was associated with significant side effects, including lymphedema, nerve damage, and shoulder dysfunction.

Advanced techniques offer several advantages:

1. Reduced Morbidity: SLNB and targeted approaches significantly reduce the risk of lymphedema and other complications.
2. Faster Recovery: Less extensive surgery means quicker healing and return to normal activities.
3. Improved Quality of Life: Preservation of healthy lymph nodes and vessels leads to better long-term outcomes and arm function.
4. Precision: Advanced techniques allow for more accurate staging and tailored treatment plans.

A study comparing traditional AND to SLNB in early-stage breast cancer patients found that SLNB reduced the risk of lymphedema from 20% to 5%, while maintaining equivalent oncological outcomes.

Benefits for Pakistani Patients

These advancements offer numerous benefits for our Pakistani patients:

1. Reduced Hospital Stay: Many patients undergoing SLNB can be discharged the same day or next day.
2. Lower Complication Rates: Advanced techniques have significantly reduced the incidence of post-operative complications.
3. Improved Arm Function: Patients report better shoulder mobility and arm strength after less invasive procedures.
4. Cost-Effective: While initial costs may be higher, reduced complications and shorter hospital stays can lead to overall cost savings.

One of our patients, Fatima (name changed), shared: “I was worried about losing use of my arm after surgery. But with the sentinel node biopsy Dr. Sheikh performed, I was back to my normal activities within weeks. It made a huge difference in my recovery.”

Addressing Common Concerns

It’s natural to have questions about axillary node dissection. Let’s address some common concerns:

1. Will I lose the use of my arm?

   With modern techniques, the risk of significant arm dysfunction is low. Most patients regain full use of their arm with proper rehabilitation.

2. How painful is the procedure?

   Pain is typically manageable with medication. Most patients report mild to moderate discomfort that improves within a week or two.

3. Will I develop lymphedema?

   The risk of lymphedema is significantly reduced with SLNB. Even with full AND, proper care and precautions can minimize this risk.

4. How long will I be in the hospital?

   Many patients undergoing SLNB can go home the same day. For full AND, a 1-2 day hospital stay is typical.

5. Will I need drains after surgery?

   This depends on the extent of surgery. SLNB often doesn’t require drains, while full AND typically does for a short period.

Dr. Hammad Raza Sheikh:

Your Expert in Axillary Node Dissection

As a Consultant Oncoplastic Breast Surgeon with over 15 years of experience, I’ve performed hundreds of axillary node dissections and sentinel node biopsies. I’ve trained extensively in the latest techniques, including SLNB and ARM, and I’m committed to bringing these advanced methods to our patients in Pakistan.

My approach combines surgical expertise with a deep understanding of each patient’s unique needs. I believe in tailoring the surgical approach to provide the best possible outcome, both oncologically and in terms of quality of life.

Patient Stories: 

Let me share a few stories from our patients (names changed for privacy):

Amina, 52: “After my diagnosis, I was terrified of losing mobility in my arm. Dr. Sheikh explained the sentinel node biopsy procedure, and it made all the difference. I recovered quickly and was able to return to my job as a teacher within weeks.”

Zainab, 45: “I needed a full axillary dissection, but Dr. Sheikh used techniques to preserve important nerves and vessels. With his guidance on post-operative care, I’ve avoided lymphedema and have full use of my arm.”

Saadia, 38: “As a young mother, I was worried about how axillary surgery would affect my ability to care for my children. The minimally invasive approach Dr. Sheikh used allowed me to recover quickly and get back to my family.”

Post-Operative Care and Rehabilitation

Proper aftercare is crucial for optimal recovery. Here’s what you can expect:

1. Wound Care: We’ll provide detailed instructions on caring for your surgical site.
2. Drain Management: If you have drains, we’ll teach you how to care for them and when they’ll be removed.
3. Arm Exercises: We start gentle arm exercises early to prevent stiffness and promote healing.
4. Lymphedema Prevention: You’ll receive education on lymphedema risk reduction and early detection.
5. Follow-Up Care: Regular check-ups will monitor your recovery and address any concerns.

In the Pakistani context, we understand the importance of family support. We encourage family involvement in the recovery process and provide education to caregivers to ensure the best possible outcomes.

The Future of Axillary Surgery in Pakistan

As we look to the future, I’m excited about the potential for further advancements in axillary surgery:

1. Axillary Preservation: Ongoing research is exploring ways to safely omit axillary surgery in certain patient groups.
2. Improved Imaging: Advanced imaging techniques may allow for more accurate non-invasive staging of axillary nodes.
3. Targeted Therapies: Emerging treatments may reduce the need for extensive axillary surgery in some cases.

At Lahore Oncoplastic Breast Services, we’re committed to staying at the forefront of these advancements, ensuring that our Pakistani patients have access to the best possible care.