Lymph node removal is a common step in surgery for breast cancer. The main reason to remove the lymph nodes is to figure out how far within the body cancer has spread. This procedure is generally performed at the same time as a lumpectomy (removal of a small part of the breast) or mastectomy (removal of all the breast tissue). In some cases, the lymph nodes may be removed in a second surgery before or after a lumpectomy.

Lymph node removal and other treatments for breast cancer can increase your risk of some complications, like lymphedema. Lymphedema is a type of swelling, and it may happen in your arm on the side of your body where lymph nodes were removed.

This article tells you what to expect after lymph node removal for breast cancer and what you can do to avoid complications like lymphedema.

Why Do They Remove Lymph Nodes With Breast Cancer?

Your lymph nodes are part of your lymphatic system — a collection of vessels, organs, and other tissues. The lymph nodes help remove germs and waste products from your body. They can also filter out cancer cells from your lymphatic system.

One of the main ways that cancer metastasizes (spreads from the original site to other parts of the body) is by traveling through the lymphatic system. Cancer that is spreading from the breast first reaches the lymph nodes in the armpit or chest, so doctors remove lymph nodes to check for cancer cells. This information helps doctors determine the stage of the breast cancer (how far the cancer has spread), which helps them understand which breast cancer treatments are likely to work best.

Does Removing Lymph Nodes Stop Cancer From Spreading?

When a lymph node containing cancer cells is removed, these cells can no longer spread. This can prevent cancer from moving to other lymph nodes or metastasizing to other locations.

You might not need chemotherapy if your lymph nodes are clear after lymph node removal, but your doctor may still recommend it to kill undetected cancer cells or if you have a high risk of cancer recurrence.

Types of Lymph Node Removal

Two main types of surgery allow doctors to remove lymph nodes. The type of procedure you undergo determines how many lymph nodes will be removed. Consequently, the number of lymph nodes removed affects the side effects you are likely to experience.

Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy (SLNB) is the most common type of lymph node removal procedure. During this procedure, only a small number of lymph nodes — typically, one to five — are removed.

An SLNB allows the doctor to find the lymph node or set of lymph nodes most likely to contain cancer cells. Lymph nodes are linked in a particular order — when fluid near your tumor drains out of your breast, it first reaches one lymph node or a set of nodes before continuing to others nearby. The initial nodes are called sentinel nodes. If breast cancer cells spread, they will come to these lymph nodes first.

To find the sentinel node, the surgeon injects either a colored dye or a radioactive substance near the tumor or under the areola. In some cases, both dye and radioactivity are used. Either substance is designed to travel to the sentinel nodes, which the surgeon can then remove and check for cancer. Most of the nearby nodes will be left in place.

Axillary Lymph Node Dissection

Surgeons remove more lymph nodes during an axillary lymph node dissection (ALND) compared with an SLNB. In some cases, up to 40 lymph nodes from the underarm area may be taken out, although it’s more common to remove fewer than 20.

Surgeons may recommend an ALND if previous tests (usually a fine needle aspiration) revealed cancer cells in the lymph nodes. This procedure may also be a good idea for those who have enlarged lymph nodes, nodes that appear suspicious in the ultrasound, or very large tumors that have spread outside the area of the lymph nodes.

Removing many lymph nodes used to be a common treatment for breast cancer, but these days, that approach is less common. Taking out extra nodes won’t help get rid of cancer cells that have already spread beyond the armpit area, and it can cause additional side effects. Instead, treatments like radiation therapy are used to attempt to kill any malignant cells that remain locally, and chemotherapy that travels throughout the bloodstream aims to destroy cancer cells in other locations.

Deciding on a Lymph Node Surgery

Your doctor may check for cancer in the lymph nodes before you undergo surgery. They may look for enlarged lymph nodes, which will feel like hard lumps in your underarm area or near your collarbone, and they may use imaging tests such as an ultrasound to search for signs of cancer.

If there’s image-based or clinical evidence that your lymph nodes may contain cancer, your doctor typically will perform a fine needle aspiration and check for cancer cells using a microscope. Less commonly, a core needle biopsy can be done to sample the tissue in the lymph node.

If cancer is found in the suspicious nodes before surgery, your surgeon may plan to remove a larger number of nodes with an axillary lymph node dissection. Otherwise, they may suggest a sentinel node biopsy. Before surgery, you may want to ask your doctor which procedure they plan to perform and explore the benefits and risks of each.

Preparing for Surgery

Make sure to follow all your doctor’s instructions for getting ready for your surgery. They may tell you to stop taking certain medications such as blood thinners or supplements before the operation. Your surgeon may also say that you can’t eat anything for eight hours before the surgery.

SLNB involves using a dye or a radioactive substance to check the lymph nodes. The radioactive liquid may be injected a several hours before surgery by the nuclear medicine department, but if the surgeon is using dye, they will inject it during the operation.

What To Expect During Surgery

Before surgery, you will be placed under general anesthesia so that you can’t feel or remember anything.

Your surgery’s length depends on the procedures being performed. For example, a lumpectomy plus SLNB may take about an hour. A mastectomy with an ALND, or a procedure that involves breast reconstruction, could take three hours or longer. The type of surgery and your overall health will determine whether you go home the same day or stay in the hospital for a couple of nights.

What To Expect After Lymph Node Removal

In the days following surgery, you will need help getting back on your feet. Additionally, you’ll have to watch out for potential long-term problems.

Meanwhile, the removed lymph nodes will be examined in the laboratory for cancer cells. Any cancer cells present will be studied in detail for clues that help your doctor predict the cells’ growth patterns. As your doctor receives lab results, they may begin to recommend which treatments, if any, should come next.

Recovering From Surgery

Any surgery comes with potential complications. Your surgical team should explain which problems can arise during or after the procedures. Signs and symptoms to watch out for may include:

• Redness or discoloration, soreness, or swelling around your incision, which could indicate an infection
• Fluid or blood collecting around the incision site, which sometimes needs to be drained
• Sudden pain or swelling in your leg or chest pain and shortness of breath, which could be a sign of blood clots

Make sure to follow any other instructions from your surgeon. They should explain how to care for your incision and whether you need to change any bandages. Your surgeon may also tell you to avoid certain types of activities or movements or perform certain exercises that can help you heal.

Surgery will likely affect your daily activities for several weeks, and during that time you also may experience ongoing soreness or tiredness. Your surgeon will tell you when it is safe to return to your usual activities, such as driving and going to work.

If you underwent an SLNB and your surgeon used blue dye to find the sentinel node, you may have blue or green urine or notice blue markings under your skin for a couple of days after surgery.

Determining Your Stage

When determining your cancer stage, doctors will consider three factors: how big the initial tumor is, whether cancer can be found in the lymph nodes, and whether cancer cells are present in other parts of the body. You won’t know your cancer stage until after the breast lump is removed and after the lymph node removal surgery.

If cancer is found in the lymph nodes, you will have a higher cancer stage. For example, stage 1 and 2 tumors are generally small and haven’t spread to the lymph nodes. Stage 4 breast cancer, however, includes tumors of any size that have spread to many lymph nodes metastasized to other locations.

Your doctors will use this information to help plan your treatment. For example, advanced-stage tumors (3 and 4) require more aggressive treatment options compared with early-stage breast cancer.

Next Steps for Treatment

During an SLNB, doctors find out right away whether the nodes contain cancer. This is possible because during the surgery, they send the sentinel lymph nodes to the pathologist so that the results are back within about half an hour. If the sentinel node is positive (has cancer cells) the surgeon may take out additional lymph nodes, and it will take several days to get your results.

Having lymph nodes that are free of cancer means that there is no reason to take out any more lymph nodes. Your doctor may then recommend additional treatments like radiation therapy, chemotherapy, targeted therapy, or hormone therapy to make sure any cancer cells are stopped from growing.

If cancer cells are discovered in the lymph nodes, this may be a sign that cancer has moved elsewhere. Therefore, you may need imaging tests to see whether cancer cells can be detected in other parts of your body.

You may also need to have more lymph nodes taken out in a second surgery if your sentinel nodes contain cancer. However, further lymph node removal isn’t always helpful, especially for those with early-stage cancer who have undergone a lumpectomy, so doctors don’t recommend additional surgery as often as they used to.

How To Avoid Lymphedema After Lymph Node Removal

One of the most common long-term effects of lymph node removal surgery is lymphedema. This condition occurs when too much fluid collects in the breast, arm, chest, or abdomen and the area swells up. You are more likely to experience lymphedema if you have an ALND, if you undergo a mastectomy, or if your lymph nodes are treated with radiation. Smoking cigarettes and having diabetes are also lymphedema risk factors.

You can lower your risk of lymphedema by avoiding tight-fitting clothing or jewelry, including rings and watches, on the arm that was operated on. If you get any cuts or wounds on that arm, wash the area and use an antibiotic ointment to avoid infections. Additionally, avoid getting blood draws, shots, or blood pressure readings on that arm.

Other Long-Term Side Effects and How To Avoid Them

Other surgery complications may also last long-term. For example, surgery may lead to nerve damage that causes numbness or tingling. These sensations often decrease over time and exercise and physical therapy can help relieve them. Other possible long-term side effects of lymph node removal in the armpits include:

• Scar tissue in your armpit that limits movement (axillary web syndrome)
• Seroma (fluid buildup at the surgical site)
• Infection at the surgical site

You may also have a hard time moving your arm and shoulder around after surgery. Certain exercises from your doctor may help you regain flexibility in this joint.

To avoid long-term side effects after lymph node removal, follow your surgeon’s aftercare instructions. You should also be sure to attend all follow-up appointments to monitor your recovery. Contact your health care provider with any concerns.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 74,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you undergone lymph node removal? What advice would you share with those facing this procedure? Share in the comments below, or start a conversation by posting on your Activities page.