Early-Stage Breast Cancer After Menopause: Is Axillary Lymph Node Surgery Right for Me?

You'll have surgery to remove the tumor in your breast. Treatment after the surgery will probably include several years of hormone therapy. You may or may not need other treatments.

You'll also have a sentinel lymph node biopsy.

• This will probably be done during the surgery on your breast.

• A dye or a tracer, or both, will be injected into the area around the tumor in your breast. The dye will move to and show up in nearby lymph nodes. This could be one to several nodes.

• The surgeon will remove these lymph nodes from under your arm. The nodes will be tested for cancer.

If the nodes from the biopsy contain cancer, you may have more lymph nodes removed in an axillary dissection.

• This sometimes happens during the same procedure as the biopsy. But often it's a separate surgery.

• The surgeon will make a cut (incision) in your side, under your arm.

• You'll have many, most, or all the lymph nodes under your arm removed.

Depending on how many lymph nodes are removed, you'll need to be careful with your arm for the rest of your life.

You'll have breast-conserving surgery (lumpectomy) to remove the tumor in your breast. Treatment after the surgery will probably include several years of hormone therapy. You may or may not need other treatments.

You won't have any lymph nodes under your arm removed.

Five years after their diagnosis, 97 to 98 women out of 100 will still be alive. You have the same chance of surviving with or without axillary surgery.

If you want to be as sure as you can that you have found and removed all the cancer, surgery to biopsy the lymph nodes may bring you some peace of mind.

In some cases, a biopsy of axillary lymph nodes can help a person decide on some of the details in a treatment plan.

Five years after their diagnosis, 97 to 98 women out of 100 will still be alive. You have the same chance of surviving with or without axillary surgery.

You avoid a biopsy that could lead to treatments that may hurt you more than they help you. These could include a second surgery to remove more lymph nodes or chemotherapy.

You avoid the risk of long-term swelling (lymphedema), pain, and other problems with your arm.

Your decision is not likely to change the risk of cancer spreading or coming back. With axillary surgery:

• Cancer will spread (metastasize) in about 2 out of 100 women.

• Cancer will come back (recur) in 1 to 2 women out of 100.

If the biopsy shows cancer, it could lead to treatments like more lymph node removal or chemotherapy, even though they may not help you.

Removing lymph nodes can cause problems with your arm. You could have:

• Swelling (lymphedema).

• Reduced ability to move your arm or shoulder.

• Tingling, burning, or loss of feeling in your arm.

These problems with your arm can happen right away or months or years later. They can last a short time or be a lifelong problem.

The risk of lymphedema is fairly low with biopsy because it requires removing only a few nodes. But if the biopsy shows cancer and you have more nodes removed, the risk will go up.

Your decision is not likely to change the risk of cancer spreading or coming back. Without axillary surgery:

• Cancer will spread (metastasize) in about 2 out of 100 women.

• Cancer will come back (recur) in 1 to 2 women out of 100.

If you have a sentinel lymph node biopsy at the same time as your breast surgery, your recovery will be about the same as with the breast surgery. Plus:

• You'll have some added soreness and swelling in the area where the lymph nodes were taken out.

• You may have numbness or tingling in your armpit or on the inside of your upper arm.

• You may have a separate incision.

If you have many more lymph nodes removed, your recovery will be longer.

• You will probably be able to go back to your normal routine in 3 to 6 weeks. This depends on what your routine is and any further treatment.

• You will need to avoid lifting anything heavy for 4 to 6 weeks.

From now on, you will need to try to protect your hand and arm from injury and infection. And you'll need to watch for changes in your arm.

You'll need time to heal after the lumpectomy.

• For 1 or 2 days after the surgery, you will probably feel tired and have some pain.

• You may have swelling, soreness, and bruising around the incision. Soreness should go away in a few days.

• You will need to avoid lifting anything heavy for 1 to 2 weeks.

• You will probably be able to go back to your normal routine in 1 to 3 weeks. This depends on how you feel and what kind of routine you have. It may also depend on any other treatment you are having.