Axillary web syndrome after axillary dissection

doi:10.1016/S0002-9610(01)00602-X

The American Journal of Surgery

Volume 181, Issue 5, May 2001, Pages 434-439

https://doi.org/10.1016/S0002-9610(01)00602-X Get rights and content

Abstract

Background: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS).

Methods: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND.

Results: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (≤90° in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels.

Conclusions: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.

Section snippets

Methods

The senior author (REM) maintained a personal database of 750 consecutively treated or clinically evaluated breast cancer patients over the 16-year period 1980 to 1996. Review of this database revealed 44 patients with the signs and symptoms of AWS. In each of the 44 cases, the medical record was obtained, reviewed, and abstracted. Additionally, our surgical oncology group observed 4 patients who developed AWS after SLND for staging of early breast cancer. These charts were also obtained,

Physical characteristics of axillary web

The defining characteristic of this syndrome is a visible web of axillary skin overlying palpable cords of tissue that are made taut and painful by shoulder abduction (Fig. 1). The web is always present in the axilla and extends into the medial ipsilateral arm, frequently down to the antecubital space, and occasionally to the base of the thumb. Typically, there are two or three taut, tender, nonerythematous cords of tissue under the skin. Notably, the axillary web is neither immediately

Comments

Axillary web syndrome is a self-limited process that developed in 6% of the patients with invasive breast cancer treated by a single surgeon over a 16-year period. Although patients who develop AWS were treated with nonsteroidal anti-inflammatory medications, physical therapy, and range-of-motion exercises, our data failed to demonstrate that the treatments shortened or changed the self-limited course of the syndrome. We identified no long-term sequelae of AWS. Eleven percent of AWS patients

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Axillary web syndrome after axillary dissection

Abstract

Section snippets

Methods

Physical characteristics of axillary web

Comments

Ann Oncol

Eur J Surg Oncol

J Hand Surg

Prognostic factorsstage and receptor status in breast cancer

Cancer

Impact of axillary node dissection on the therapy of breast cancer patients

J Clin Oncol

Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases

Cancer

Pathologic findings from the National Surgical Adjuvant Project for Breast Cancers (protocol no. 4)

Cancer

Risk of lymphoedema following treatment of breast cancer

Br J Surg

Arm problems and psychological distress after surgery for breast cancer

Can J Surg

Assessment of arm morbidity from complete axillary dissection

Br J Cancer

Physical and psychological morbidity after axillary lymph node dissection for breast cancer

J Clin Oncol

Pain and other symptoms during the first year after radical and conservative surgery for breast cancer

Br J Cancer