Lymph Node Removal
Also known as: lymphadenectomy, lymph node dissection
Lymph node removal is a surgical procedure in which one or more lymph nodes are taken out to check for or treat the spread of cancer.
What is a lymph node?
Lymph nodes are small, bean-shaped structures that act as filters for lymph fluid, trapping bacteria, viruses and other foreign substances, including cancer cells. When cancer cells break away from the primary tumour, they can travel through the lymphatic system to nearby lymph nodes. If cancer cells are found in the lymph nodes, it shows that the cancer has started to spread beyond the original site – but how far and how fast depends on the cancer type and biology. Lymph node surgery helps stage the tumour and control the disease in the regional nodes. Whether it reduces the risk of cancer coming back in the nodes depends on the cancer type and the rest of your treatment (systemic therapy and radiotherapy). Your healthcare team will tailor the plan to suit your needs.
Types of lymph node surgery
There are several types of lymph node surgery, each for specific conditions and needs. Understanding these procedures will help you know what to expect and how they fit into your overall treatment plan.
Sentinel Lymph Node Biopsy
Sentinel lymph node biopsy is less invasive than ALND. It involves identifying and removing the first lymph node (or nodes) to which cancer cells are likely to spread from the primary tumour, known as the sentinel node. The surgeon injects a radioactive substance or blue dye near the tumour to locate the sentinel node. Once the sentinel node is identified, it is removed and examined for the presence of cancer cells. If the sentinel node contains cancer, options are observation with radiotherapy or ALND, depending on the number of involved nodes, tumour features and planned breast surgery. This procedure helps stage the cancer and determine the extent of its spread, allowing for more targeted treatment.
Axillary Lymph Node Dissection (ALND)
Axillary lymph node dissection (ALND) is a surgical procedure used to treat breast cancer that has spread to the lymph nodes in the armpit area, known as the axilla. During this procedure, the surgeon removes levels I and II of the armpit; the number of levels removed varies by person. Level III nodes (located higher in the axilla) are only removed in select cases. These lymph nodes are then sent to the lab to see if cancer cells are present. This helps stage the cancer and plan further treatment. It’s usually considered when there’s confirmed or residual nodal disease, though many patients with limited sentinel node involvement can avoid ALND and have radiotherapy instead.
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Ways to payBefore surgery
The initial consultation is the first step in the lymph node removal process. During this appointment, your breast surgeon or oncologist will review your medical history, discuss your diagnosis and explain why lymph node removal is recommended in your case. They will outline the different surgical options, including sentinel lymph node biopsy and axillary lymph node dissection, and help you understand which one is best for you based on your cancer type, stage and overall health.
You will also have the opportunity to ask questions about the surgery, its risks, benefits, and what to expect during recovery. It’s essential to be open about any concerns or preferences you have, so that your healthcare team can tailor the treatment plan to your individual needs. Your surgeon may also discuss preoperative tests or imaging studies needed to plan the surgery more precisely.
If the lymph nodes in your underarm appear swollen or abnormal on imaging, your doctor may recommend a core needle biopsy or a fine needle aspiration (FNA). These procedures remove a small sample of tissue or cells from the lymph node to check for cancer. Confirming whether cancer is present in the lymph nodes helps guide the surgical plan and may reduce the need for more invasive procedures later.
The initial consultation may also include a discussion about the possibility of a second operation if more lymph nodes need to be removed after the first procedure, mainly if cancer cells are found in the sentinel nodes. Knowing this can help you mentally and physically prepare for the treatment journey ahead.
Overall, the initial consultation sets the foundation for informed decision-making and helps establish a trusting relationship between you and your surgeon, which is key to successful treatment and recovery.
During surgery
The surgery is performed under general anaesthesia, meaning that you will be fully asleep and pain-free throughout.
A sentinel lymph node biopsy is usually the first step. The surgeon injects a small amount of dye and/or a weak radioactive tracer near the tumour site. These substances travel the same path cancer cells would take, highlighting the sentinel nodes – the first lymph nodes that drain the breast. Through a small incision in the underarm, the surgeon removes one or a few of these nodes for testing. If they are free of cancer, no further lymph node surgery is usually needed.
If cancer cells are found or if there are other clinical reasons, the surgeon may perform an axillary lymph node dissection. This involves making a longer incision in the underarm to remove a larger group of lymph nodes (typically 10-20). This provides more detailed information about the extent of the disease and may help prevent cancer from spreading further.
After surgery
Immediate post-surgery care
After surgery, you will need to be closely monitored by the nursing team. Sutures, staples, or surgical clips may need to be removed, depending on how the wound was closed. A wound drain may also be used to prevent fluid from building up around the surgical site.
Long-term recovery
Long-term recovery after surgery can vary from person to person. Some may experience complications like seromas or lymphedema. Seromas (fluid collections) often resolve within weeks, but lymphedema can persist or recur and may need long-term management with physiotherapy, massage or compression sleeves.
Some patients may have limited mobility in their arms and shoulders after surgery. Not everyone will need treatment for conditions like axillary web syndrome, but physical therapy may be recommended to alleviate pain and improve movement. This can be an essential part of the recovery process, helping patients regain their range of motion and strength.
Risks and complications of lymph node surgery
As with any surgery, there are certain risks and complications.
These can include:
- Pain and discomfort
- Swelling and bruising
- Lymphedema (swelling of the arm)
- Infection
- Numbness or tingling in the upper arm
- Limited arm and shoulder movement
- Axillary web syndrome (a condition that causes pain and stiffness in the arm and shoulder)
- Seromas (fluid build-up under the arm) – common but usually resolve or can be drained
- Deep vein thrombosis (a blood clot that forms in the deep veins of the leg)
Not everyone will experience these side effects, and your healthcare team will discuss your personal risks and how to reduce them. Being informed will help you make the best decisions for your health and recovery.
Appointment and Treatment Plan
Initial Consultation
Your surgeon reviews your history, explains why lymph node removal is recommended, discusses sentinel biopsy versus axillary dissection, and may arrange imaging or a biopsy to guide the surgical plan.
Preparation
You have the chance to ask questions, review risks and benefits, and complete any required tests; your doctor may also explain the possibility of a second procedure if more nodes need to be removed.
Surgery
Under general anaesthesia, the surgeon first performs a sentinel lymph node biopsy using dye or a tracer to identify and remove a few key nodes, and if cancer is found or suspected, may proceed with axillary lymph node dissection to remove a larger group.
Immediate Post-surgery Care
You are monitored closely after surgery, the wound is closed with sutures or clips, a drain may be placed, and you are given instructions on wound care and follow-up.
Long-term Recovery
Recovery varies, with some patients experiencing fluid collections, swelling, or reduced arm mobility; physiotherapy, massage, or compression sleeves may be advised to manage symptoms and restore movement.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
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FAQs
Yes, you can. The body has hundreds of lymph nodes throughout the lymphatic system, and only a small number are removed during surgery. Your immune system continues to work because the remaining nodes and other defences take over. However, removal can make fluid drainage less efficient in the affected area, which sometimes leads to lymphedema (swelling, usually in the arm after breast surgery). This is why follow-up care, exercises, and monitoring are essential to reduce and manage this risk.
Finding cancer in the lymph nodes means it has spread beyond the breast, but the pace depends on the type and biology of the cancer. Node status helps doctors plan the best treatment, such as chemotherapy, radiotherapy, or targeted therapy.
Removing lymph nodes is considered a serious surgery as it involves removing vital parts of the lymphatic system. The complexity of the procedure depends on the number of lymph nodes being removed and their location. For example, axillary lymph node dissection involves removing multiple lymph nodes from the underarm area and is usually done under general anaesthesia. While the surgery itself is generally safe, it carries risks and complications like infection, blood clots and lymphedema. Patients must discuss these risks with their healthcare provider and follow post-operative care instructions to ensure smooth recovery.
If cancer is found in one lymph node, it means the cancer has spread from its original site. Cancer cells in a lymph node can affect the staging of the tumour, which in turn affects treatment decisions. In this case, additional lymph nodes may need to be examined or removed to determine the extent of spread. Treatment plans often include a combination of surgery, chemotherapy, radiation therapy or targeted therapy to treat the cancer. Finding cancer in a lymph node highlights the importance of regular monitoring and follow-up care to manage the disease and prevent further spread.