Lymph Node Surgery

The most common place for breast cancer to spread to is to the lymph nodes under the arm. Removal of lymph nodes from under the arm is done to determine if the cancer has spread and to help stage the cancer. This is important in planning further treatments. Our surgeons from The Breast Center will remove the nodes so that the pathologist can examine them under the microscope using special tests. Lymph node surgery is done either by removing a sentinel lymph node or nodes and/or by doing an axillary lymph node dissection.

Sentinel Lymph Node Surgery

A sentinel lymph node biopsy is a procedure that allows your surgeon to determine that lymph node or lymph nodes in your armpit are most at risk for having trapped a breast cancer cell. This procedure can be done at the same time as any of the breast cancer operations and is nearly always done if the cancer is invasive. In order to determine which lymph node(s) is draining your breast, your surgeon will inject one or two dyes into the skin of your breast after you are asleep. These dyes will be picked up by the lymph channels and will travel to the lymph nodes, mapping the drainage of your individual breast. One dye is called technetium, which is radioactive. A handheld gamma probe (like a Geiger counter) will be used in the operating room to locate the correct lymph node. The other dye is deep blue in color and can be seen trapped in a lymph node. Sometimes the lymph nodes will be sent directly to pathology, while you're still asleep for a frozen section or rapid screening. This information may be used by your surgeon to determine whether additional nodes need to be removed. It is important to understand your surgeon's plan prior to your operation.

Axillary Lymph Node Dissection

An axillary lymph node dissection is done when there are lymph nodes that can be easily felt in your axilla (armpit). It may also be necessary if your sentinel lymph nodes show signs of cancer spread. A more extensive removal of lymph nodes will be done (usually between 10 and 20 nodes), and a drain will be placed through your skin. Most patients will stay overnight after this procedure.

All lymph node procedures carry some risk of arm swelling called lymphedema. This occurs in 3 to 8 percent of patients having a sentinel lymph node biopsy, and 15 percent of women having an axillary lymph node dissection. Although there is no way to absolutely prevent lymphedema, certain factors are known to increase its risk. These include obesity, postoperative infections, and radiation after lymph node removal. There are some techniques to minimize the risk of lymphedema; please click here to learn how.