Evaluation of muscle atrophy after axillary lymph node dissection

Axillary node status is the most important prognostic factor for patients with primary breast carcinoma, making axillary lymph node dissection (ALND) a standard surgical treatment of breast cancer. Postoperative sequelae to ALND is frequently reported. In this study we aimed to find out objectively, how much damage is caused to these nerves during ALND.

A total of 50 breast cancer patients who underwent surgical treatment in our Breast and Endocrine Surgery Unit between March 1998 and July 2004 were included in the study. Surgical treatment of these patients consisted of breast conserving surgery or total mastectomy combined with ALND. To compare operated patients with non-operated patients as a control, only patients who had undergone unilateral surgery were included in the study so that the non-operated side served as the normal control for each patient. All patients had a postoperative review with an anatomical and functional examination at least 6 months after the operation. Computed tomography was then performed and the M. latissimus dorsi (MLD), M. pectoralis major (MPM) and M. serratus anterior (MSA) thicknesses were measured.

On physical examination, the aforementioned muscles in all the patients were found to be intact and functional. Sixty-four percent of the operated patients group were found to have various degrees of hypoesthesia. MLD, MPM and MSA amongst the non-operated patients group were found to be significantly thicker than the corresponding muscles amongst operated patients group.

We conclude that a significant amount of reduction in the thickness of the MLD, MPM and MSA occurs after ALND. Also, sensory deficit occurs, especially on the upper medial portion of the arm, showing damage to the intercostobrachial nerves.