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Axillary Reverse Mapping

Axillary reverse mapping (ARM) has been developed to map and preserve arm lymphatic drainage during axillary lymph node dissection (ALND) and/or sentinel lymph node (SLN) biopsy. This technique minimizes arm lymphedema (swelling) resulting from the surgical removal of underarm lymph nodes. The risk of lymphedema is approximately 5% following sentinel node biopsy when 1 to 3 lymph nodes are removed. The procedure is done following these steps:

  • your doctor injects a blue dye into the nearby arm, which temporarily colors the lymph fluid of the arm blue
  • the doctor removes the breast lymph nodes, while very carefully avoiding removal or injury to blue colored arm lymph nodes and lymph vessels

Protection of arm nodes and lymph vessels preserves the drainage of lymph fluid from the arm, thereby preventing or reducing the risk of lymphedema. Axillary reverse mapping adds approximately 20-30 minutes to the length of the operation. Mapping may also be done by isotope injection or by fluorescent imaging.

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