Lymph Node Surgery
Axillary Lymph Node Surgery for Breast Cancer
Axillary lymph node surgery is an important part of breast cancer treatment and involves assessment and management of the lymph nodes within the armpit (axilla). The lymph nodes are often the first place breast cancer cells may spread outside the breast, making axillary surgery important for staging, treatment planning, and long-term cancer management.
The type of axillary surgery recommended depends on several factors including tumour biology, imaging findings, biopsy results, and whether cancer is present within the lymph nodes. Modern breast cancer treatment aims to provide effective cancer management while minimising the impact of surgery and reducing the risk of long-term complications such as lymphoedema.
A/Prof Farid Meybodi provides personalised breast cancer care using modern surgical and oncoplastic techniques tailored to each patient’s diagnosis and treatment goals.
Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is commonly performed when there is no obvious evidence of cancer spread to the lymph nodes prior to surgery.
The sentinel lymph nodes are the first lymph nodes that drain fluid from the breast and are therefore the most likely nodes to contain cancer cells if spread has occurred. During surgery, a small amount of tracer and/or blue dye is used to identify these nodes, which are then carefully removed and examined by a pathologist.
If the sentinel lymph nodes do not contain cancer, additional lymph node surgery may not be necessary. Sentinel lymph node biopsy is generally associated with:
- smaller incisions
- quicker recovery
- less discomfort
- lower risk of lymphoedema compared with more extensive axillary surgery
Targeted Axillary Dissection (TAD)
Targeted Axillary Dissection (TAD) is a newer surgical approach used in selected patients with breast cancer involving the lymph nodes, particularly those who receive chemotherapy before surgery (neoadjuvant chemotherapy).
This technique combines removal of the sentinel lymph nodes together with removal of a lymph node previously confirmed to contain cancer at biopsy and marked with a clip or localisation device before treatment. By specifically targeting the known affected lymph node, TAD can provide a more accurate assessment of how the cancer has responded to chemotherapy.
In selected patients, Targeted Axillary Dissection may help avoid the need for a full axillary lymph node dissection, reducing the risk of complications such as:
- lymphoedema
- arm stiffness
- numbness
- discomfort
- restricted shoulder movement
Not all patients are suitable candidates for TAD, and recommendations are individualised based on imaging, tumour biology, treatment response, and multidisciplinary team assessment.
Axillary Lymph Node Dissection
An axillary lymph node dissection involves removal of a larger number of lymph nodes from the armpit and may be recommended when there is more extensive lymph node involvement or persistent disease following chemotherapy.
This procedure may be advised when:
- Cancer is confirmed within multiple lymph nodes
- Abnormal lymph nodes remain after chemotherapy
- Additional staging information is required
- More comprehensive treatment of the axilla is necessary
Axillary lymph node dissection provides important information for treatment planning and may help reduce the risk of cancer recurrence within the axilla. It can also assist multidisciplinary teams in guiding recommendations for chemotherapy and radiation therapy.
Recovery After Axillary Surgery
Recovery following axillary surgery varies depending on the type of procedure performed and whether breast surgery or reconstruction is undertaken at the same time.
Some temporary symptoms following surgery may include:
- Discomfort or tightness under the arm
- Numbness or altered sensation
- Reduced shoulder movement
- Swelling or fluid collection (seroma)
Patients are provided with detailed post-operative instructions regarding wound care, exercises, activity levels, and follow-up care. Physiotherapy and lymphoedema prevention strategies may also be discussed where appropriate.
Risks & Potential Complications
As with all surgical procedures, axillary surgery carries some risks and potential complications. These may include:
- bleeding
- infection
- seroma (fluid collection)
- numbness or altered sensation
- shoulder stiffness
- lymphoedema (arm swelling)
Every effort is made to minimise these risks through careful surgical technique, modern treatment approaches, and comprehensive post-operative care.
Multidisciplinary Breast Cancer Care
Modern breast cancer treatment often involves a coordinated multidisciplinary approach involving breast surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, breast physicians, and physiotherapists.
A/Prof Farid Meybodi works closely with multidisciplinary breast cancer teams to provide evidence-based, personalised care focused on cancer management, recovery, cosmetic outcomes, and long-term wellbeing throughout every stage of treatment and recovery.
