I was told that axillary node removal only affected the relevant arm, that's
why we're supposed to take very good care of that arm. Skin care was
stressed, not damaging is in any way, it's particularly susceptible to
infection which can be dangerous. I was careful at first but never bothered
with skin care - couldn't remember and my skin isn't drier on that arm than
the other.

There's also the problem of lymphoedema ... we were taught to very lightly
stroke the arm's skin in an upward direction. The theory was that this
encouraged the generation of tiny lymph nodes. I don't know if that theory
has gone by the board though.

Mary

There are two main effects of removing the lymph nodes, one is increased
susceptibility to spread of infection from the affected arm (or breast),
should it get infected, the other is degraded lymph drainage.

The following is an engineer's view of how it works.

The lymph system is the hydraulic equivalent of an electrical earth
(ground) wire.  Fluid constantly diffuses from the high-pressure blood
circulation, and has to go somewhere or pressure will build up.  The
lymph ducts drain this fluid, combine it with nutrients from the
digestive system, and put it back into the circulatory system at a low
pressure point, a vein near the neck.

The axillary lymph nodes mostly drain the arm and the tissues of the
chest that are outside the rib cage.  The lymph system is a multiply
connected network, and there are other lesser drainage paths, the
breasts also connect to each other and to the liver for example.

The lymph nodes are like filters in the lymph system, and they are a
major killing field for the immune system.  Most invading organisms end
up in the lymph, and the nodes 'compost' anything infectious before
letting it into the blood stream.  The number of nodes present varies
considerably from individual to individual.

So removal of the nodes obviously degrades the immune protection; and
the physical damage (or the cancer itself) often causes constriction of
the lymph ducts, so that they do not relieve the diffusion pressure as
well as they should.  This way lies lymphedema.  Increased lymph
pressure causes the tissues to swell. This can either be because of
increased lymph flow, typically due to inflammation, or because reduced
outside pressure, e.g. when flying.  If this reaches a critical peak
pressure then the skin's elasticity fails and the whole arm becomes
permanently swollen.

Lymph massage, a gentle stroking of the limb towards the heart, produces
a peristalsis-like action, encouraging the flow of lymph through the
constriction and out of the limb, reducing any swelling.

Another poster mentioned chronic itching.  One must realise that the
axilla is something of a narrow pass in the anatomy with all the
services running close together (for Brits, it is the Watford Gap of the
body).  So it is pretty inevitable that a few nerves get cut while
removing the nodes.  These nerves will attempt to reconnect unless scar
tissue completely obstructs them, this process can take several years,
and can give rise to strange sensations such as itching, sudden stabbing
pains, or sometimes muscular twitches, as the nerves come back on line.

Tim Jackson