Axillary Lymph Node Surgery

Illustration showing the axillary lymph nodes that are situated above and around the breast tissue.

What are the types of axillary lymph node surgery for breast cancer?

Sentinel lymph node biopsy (SLNB)

A sentinel lymph node is described as the first lymph node(s) that cancer cells would travel to, if the cancer has spread to the axilla. The way these nodes are identified at the operation, is by injecting 2 different types of tracers (dye) into the breast. The first dye is a radioactive dye that gets injected in the radiology department prior to surgery, which is followed by a special scan (lymphoscintigraphy) to see which nodes light up (hot nodes). The second dye is a blue dye (Patent V Blue) that gets injected at the start of the operation, and temporarily colours the sentinel nodes blue. During the operation, the “hot” nodes are identified with a gamma probe, that reacts to the radioactive dye. All hot and blue nodes (sentinel nodes) are removed and sent to the pathology lab to check for the presence of cancer cells.

Axillary lymph node dissection (ALND)

An axillary lymph node dissection (also called axillary clearance) refers to the removal of the lymph nodes from the armpit that are involved in draining the breast. In this operation a significantly larger number of lymph nodes will be removed compared to a sentinel lymph node biopsy. This procedure is recommended for patients that have known cancer cells in the lymph nodes, either found pre-operatively on imaging or after having undergone a sentinel lymph node biopsy.

What are the risks of axillary lymph node surgery?

The general risks include bleeding, infection, damage to the nerves in the axilla, fluid collection (seroma) and lymphoedema (swelling of the arm). Rarely, patients will experience an allergic reaction to the blue dye, which may require further management. The risks are higher with an axillary lymph node dissection compared to a sentinel lymph node biopsy. Patients who undergo an axillary lymph node dissection will routinely have a drain inserted, which will be removed once the output decreases. Dr Bell will discuss your risks with you at the time of consultation, as well as some strategies to minimise the chances of getting lymphoedema.