Hand and Arm Guidelines After Your Axillary Lymph Node Dissection

This information describes how to prevent infection and reduce swelling in your hand and arm after your axillary lymph node dissection surgery.

Your Lymphatic System

Your lymphatic system is made up of lymphatic vesselslymph nodes, and lymphatic fluid.

  • Lymphatic vessels are tiny tubes, similar to blood vessels, which carry fluid to and from your lymph nodes.
  • Lymph nodes are small bean-shaped glands located along your lymphatic vessels. Your lymph nodes filter out bacteria, viruses, cancer cells, and other waste products.
  • Lymphatic fluid is the clear fluid that travels through your lymphatic system. It carries cells that help fight infections and other diseases.
  • Axillary lymph nodes are a group of nodes found in your armpit that drain the lymph fluid from the breast and arm. The number of nodes varies from person to person.

Your lymphatic system has 2 functions:

  • It helps fight infection.
  • It helps drain fluid from your body.

During your surgery, your surgeon removed a portion of the lymph nodes from under your arm. This may prevent your lymphatic system from working properly.

If you get an infection in the arm on the side of your surgery, your body will produce extra white blood cells and lymph fluid to fight it. The extra fluid may cause swelling, called lymphedema. Lymphedema can occur in the arm, hand, breast, or torso on the side where your lymph nodes were removed.

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Preventing Infection

A cut or burn on the hand or arm on the side of your surgery can lead to an infection. To reduce your risk of infection, follow the suggestions below:
  • Use lotion or cream to keep your hands and cuticles soft. Do not use scissors to cut your cuticles; instead, push them back with a cuticle stick.
  • Wear protective gloves when doing yard work or gardening.
  • Wear protective gloves when cleaning with harsh detergent or steel wool, and while washing dishes.
  • Wear a thimble when sewing; avoid needle and pin pricks.
  • Use an insect repellent to prevent insect bites.
  • Take care when using a razor to remove hair under your arm; consider using an electric razor. Do not use a straight razor or hair removal (depilatory) cream because they can cause breaks in your skin.
  • Take care not to get sunburned. Use a sunblock with an SPF of at least 30 and reapply it often.

Caring for cuts and scratches

  1. Wash the area with soap and water.
  2. Apply an antibiotic ointment, such as Bacitracin® or Neosporin®, to the area.
  3. Cover the area with a clean, dry gauze or a Band-Aid®.
  4. Watch for signs of infection, including redness, swelling, increased heat, or tenderness.

Caring for burns

  1. Apply a cold pack or cold water to the burn for 15 minutes.
  2. Wash the area with soap and water.
  3. Cover the area with a clean, dry gauze or a Band-Aid®.
  4. Watch for signs of infection, including redness, swelling, increased heat, or tenderness.

Call Your Doctor or Nurse if:

  • Any part of your arm, hand, breast, or torso on the side where your lymph nodes were removed:
    • Feels hot
    • Is red
    • Is more painful
    • Is more swollen
  • You have a temperature of 101º F (38.3º C) or higher
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Preventing Swelling

Right after your surgery

You may have some mild swelling in your arm right after your surgery, which may continue for up to 6 weeks. This swelling is temporary and will gradually go away. You may also feel pain or other sensations, such as twinges and tingling, after your surgery. These feelings are common and are not necessarily signs of lymphedema. The following tips will help relieve the swelling:

  • Continue to do your exercises 5 times per day or as you were instructed. Exercise your arm until you regain your normal range of shoulder and arm movement. This can take 4 to 6 weeks after surgery. It may be helpful to continue doing the stretching exercises even longer, if you feel a stretch in your chest or under your arm. If you do not regain your normal range of motion after 4 to 6 weeks, call your doctor or nurse.
  • Open your hand slowly and stretch out your fingers. Close your hand gently and make a fist. Repeat this exercise 10 times, and then rest. Repeat this exercise a few times a day.
  • If you sleep on your back, elevate your arm on 1 or 2 pillows at your side. If you are able to sleep on the opposite side of your surgery, place 1 or 2 pillows in front of you. Rest your arm on those pillows. If you had breast reconstruction, make sure not to move your arm any higher than you were instructed.

Over the long term

There is no sure way to prevent lymphedema. However, we suggest you follow the guidelines below to decrease your risk:

  • Have your blood drawn and shots given on your unaffected arm. If you had an axillary lymph node dissection on both sides, talk with your doctor about which arm would be safest to use.
  • When you resume exercise and activity after your surgery, make sure to build up your routine gradually. At first, use your unaffected arm or both arms to carry heavy packages until you get your strength back on the side of your surgery.
  • Exercise and stretch your muscles on a regular basis. If you feel discomfort, stop and take a break. Check with your doctor or nurse before you resume any strenuous exercise, such as lifting weights or playing tennis.
  • Try to maintain your normal weight, or safely work towards a more ideal body weight.
  • If you develop swelling in your arm or hand, make a note of when it started. If it does not go away after 1 week, call your doctor or nurse.
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Signs of Lymphedema

Lymphedema can develop suddenly or gradually, and can occur months or years after your surgery. Watch for signs of lymphedema, which include:

  • A feeling of heaviness or aching in your breast, arm, hand, or fingers
  • The skin of your arm, hand, or breast feeling tight
  • Decreased flexibility in your arm, hand, or fingers
  • Swelling or changes in your skin, such as tightness or pitting (skin that stays indented after being pressed). You may notice:
    • The veins in the hand on your affected side are less noticeable than on the other hand.
    • The rings on the finger(s) of your affected side are tighter or do not fit.
    • The shirt sleeve on your affected side feels tighter than usual.

If you have any signs of lymphedema, or you’re not sure, talk with your doctor or nurse. If you do not have signs of lymphedema, you can have your blood pressure measured on your affected side.

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