Multidisciplinary Symposium — Breast Cancer

The immediate complications of axillary node surgery are relatively insignificant. It is very uncommon for any patient to sustain serious injuries such as brachial plexus nerve or axillary vein injury, and although seroma formation is a very frequent occurrence it is well tolerated and is rarely prolonged. Delayed complications and long-term morbidity are by contrast commonplace and impact on the lives of many individuals. The principle symptoms that may be encountered after axillary surgery are arm swelling, susceptibility to upper limb infections, shoulder stiffness, pain and altered sensation or numbness. Quality of life studies show that lymphoedema is the most troublesome complaint. Lymphoedema Incidence: depends on degree of swelling that is used to define the condition. Serious swelling that interferes with limb function=2– 8% Significant swelling that is well tolerated=15–20% Objective arm swelling without symptoms=40% Transient early lymphoedema that resolved=7.5% Risk factors: Degree of axillary surgery (sample, level I, II or III) Obesity predisposes Incidence increases with time More common in older patients and possibly after wound infection Chronic pain Incidence=2.5%–25% Numbness/paresthesia Early post-op incidence=70–77% Resolves in 20%, improves in 60–100%, remains in 20% Shoulder stiffness Abduction reduced by >15 degrees in 9% at 1 year, other movements unaffected. Local recurrence