Breast Cancer on the Run in October: (Day 16) Axillary Dissection’s Slow Demise

OCTOBER 14: AXILLARY DISSECTION’S SLOW DEMISE

In formal doctor talk it is called the axilla. If you want to be pretentious you spell it axillae. Among friends it is call the armpit. Buried deep in this site are the skeletons of old theories about the behavior of breast cancer and the residue of now discredited operations.

The axilla. The armpit. Not one of our favorite anatomical areas. Hair grows out of it and women spend a lifetime shaving the area. All of us spend millions slathering all sorts of products in the area to camouflage embarrassing odors. It is not particularly flattering to be called “the armpit of the world, the nation, the state, whatever….”

Breast cancer surgeons have been removing lymph nodes from the armpit for decades. This is the area where breast cancer is first thought to spread once it develops initially in the breast. It was central to Halstead’s theory about the orderly spread of breast cancer.

Thus, an axillary dissection to remove all lymph nodes in the axilla, whether involved with cancer or not, is a central part of the various mastectomy procedures. In the early days of lumpectomy, an axillary dissection was done as a separate procedure. The procedure was thought to have therapeutic value, would improve the patient’s prognosis.

I used to love the operation, whether doing it as part of a mastectomy or a lumpectomy. Anatomical structures were well defined. One could easily remove the lymph nodes and any remaining  lymphatic tissue and expose all the vital muscles, veins, and nerves, just as they appear in the anatomy books.

Surgeon satisfaction aside, the operation carried with it signifiant morbidity. The most significant complication was arm swelling, which could be quite debilitatingl.

Evidence supporting the therapeutic benefit of axillary dissection was contradictory and sketchy. Its demise was slow, perhaps reflecting a peculiar kind of inertia and rigidity in the surgical community.

Changes in the perception of how breast cancer spreads and the development of the sentinel node technique dramatically sealed its fate and buried it deep in the armpit of failed theories and surgical procedures. RIP…