Lymph node surgery

Sentinel lymph node biopsy

To find out whether cancer is in the lymph nodes, a doctor removes a few lymph nodes from your underarm where the cancer is most likely to travel first. These are called the sentinel nodes.

Before surgery, you will get an injection of dye or dyes into your breast. At the time of surgery, the surgeon will look for the lymph nodes that have taken up the dye. The surgeon will send the sentinel nodes to a pathologist to test whether they have cancer. If they do not, no more nodes will be removed. If they do, your surgeon may remove more underarm lymph nodes, either at the time of your sentinel node biopsy or during another surgery.

Sentinel lymph node biopsy is usually not offered if you have:

• a locally advanced cancer, or a very large tumor that has spread within your breast
• inflammatory breast cancer
• DCIS, and you plan to have a lumpectomy

If these things are true for you, your doctor may recommend an axillary lymph node dissection. If you have DCIS and plan to have a lumpectomy, you may not need any lymph node procedure.

Axillary lymph node dissection

If cancer is found in your lymph nodes, you may need an axillary lymph node dissection, or removal of most of the lymph nodes in the armpit. An axillary lymph node dissection will help your doctors stage the cancer and recommend treatment.

Axillary dissection is a more extensive surgery than sentinel node biopsy. It has a higher risk for side effects such as shoulder stiffness and lymphedema. To address these side effects, your doctor may refer you to a physical therapist or a lymphedema specialist.

This type of surgery may not be recommended if you:

• have no cancer in the lymph nodes
• have cancer in 1 or 2 lymph nodes, and you plan on having a lumpectomy followed by radiation therapy
• plan to have radiation to the armpit area

Questions to ask your doctor

Here are some key questions to consider before surgery:

• Will I have a sentinel lymph node biopsy or axillary dissection?
• Why do you recommend one surgery over the other?
• What are the risks for short- and long-term side effects?
• Should I get neoadjuvant therapy, treatment before surgery?

Side effects of lymph node surgery

Lymph node surgery is an important part of assessing and treating breast cancer. But as with any surgery, lymph node surgery can have serious side effects. Talk with your doctors about these risks before you have surgery. They can help you understand the benefits of surgery over the risks of side effects.