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Sentinel Lymph Node Dissection and lymphatic cording

Photo shows site of Sentinel Lymph Node Dissection, and the lymphatic cording that occurred.  

What Is
Axillary Web

Most breast cancer patients will have either, or both, a sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) surgery as part of their treatment plan. Axillary Web Syndrome (AWS), also known as cording, is a condition that can develop as a side effect of either SLNB, or ALND. Surgery to the chest area to remove the cancer can create scar tissue, which in turn contributes to cording.

What Does it Look Like?

If you develop Axillary Web Syndrome, you can often see or feel a web of thick, rope-like “cords” under the skin of your inner arm. Sometimes you may not see these cords, but sensations of pain and tightness tell you that they are there!

How Do I Know If I Have Cording?

The doctors at Pratt Physical Therapy get into it below… 

How Do I Know if I Have Cording

Pratt Physical Therapy logo

You may first notice visible cords when you’re doing something that involves raising your arm to shoulder level or above your head. With cording, it’s possible to have one large cord or several distinct smaller cords running down the arm. These cords usually start near the site of any scarring from surgery in the underarm region and extend down the inner arm to the inside of the elbow. In some cases, the cords continue all the way down to the palm of your hand, or into the chest wall.

The cords tend to be tight and painful, making it difficult for you to lift your arm higher than your shoulder, or to extend the elbow fully. The pain and limited range-of-motion that accompanies cording can have a major impact on your quality of life.

How Common is Cording

We’re not certain how many people go on to develop cording after breast cancer surgery. One small study found that 20% of women develop cording after SLNB, and anywhere between 6-72% of women develop cording after the more extensive ALND surgery.

What Causes Cording

More research is needed to say for sure. Some experts believe that surgery to the underarm and chest area traumatizes the connective tissue that encases nearby bundles of blood vessels, lymph vessels, and nerves. This trauma leads to inflammation, scarring, and eventually hardening of the tissue. This hardening can spread down the fibers of the connective tissue, which causes the cords to form.

What Can I Do to Manage Lymphatic Cording

There is hope! Multiple treatment options exist to tackle the symptoms and side effects caused by cording. 
At Pratt we provide:

  1. Stretching and flexibility exercises

  2. Manual massage therapy

  3. Low-level laser therapy

  4. Cupping

  5. Decongestive lymphatic massage

  6. Dry-needling

  7. Moist heat

And when you “graduate” from our breast cancer rehabilitation program, we can also train you to do some of these treatments for yourself at home.

For questions, relating to Axillary Web Syndrome, contact: or visit

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