Level 3 Axillary Lymph Node Dissection and Risk of Lymphedema

Lymphedema following breast cancer treatment, characterized by limb pain, tightness, heaviness, and possible infections, can occur during or even years following treatments for cancer. Determining which patients are at risk for lymphedema after breast cancer may allow clinicians and researchers to provide appropriate follow-up care and education. In a recent study 190 women who underwent breast cancer treatment including level 3 axillary lymph node dissection (ALND) were followed to determine risk factors for development of lymphedema. Level 3 dissection refers to the surgical classification of the axillary lymph nodes into three compartments, defined in relationship to the pectorals minor muscle. Level 3 describes the nodes above and medial to the pectoralis minor. This page includes more information about breast anatomy and the levels of dissection.

To determine the presence of lymphedema, upper limb circumferential measurements were taken. Lymphedema was found to be present in 41.5% of the women. Of these women, 44 had stage 1, 25 had stage 2, and 10 had stage 3 lymphedema. Stage 1 lymphedema is described as pitting edema that is reversible, stage 2 as non-pitting and irreversible, and stage 3 is considered advanced lymphedema with enlarged limb volume and significant skin changes. The distribution of the lymphedema was measured as 15 cm proximal to the elbow in 94.9% of the patients, and in 73.4% it was located 10 cm distal to the elbow.

In this study, the identified risk factors for developing lymphedema included axillary radiotherapy, chemotherapy, the number of metastatic lymph nodes, age and body mass index (BMI). Because of the known increase in lymphedema prevalence in patients who experience axillary lymph node dissection versus sentinel lymph node dissection, the authors recommend that physicians should play a stronger role in identifying high-risk patients and working towards lymphedema prevention. The medical prevention of lymphedema can include more frequent and thorough follow-up after surgery, and education about modifiable risk factors such as obesity. To learn more about additional lymphedema prevention educational strategies, the Institute offers Rehabilitation for the Breast Cancer Patient with instructor Susannah Haarmann. You still have time to sign up for this course that takes place at the end of the month in the Chicago area!