Surgery to remove lymph nodes from your armpit

You might have surgery to remove most or all the lymph nodes in the armpit (axilla) close to the breast. This is called an axillary lymph node dissection (ALND) or axillary clearance.

Breast cancer can spread to other parts of the body. If it does spread, it usually first spreads to the lymph nodes in the axilla.

What are lymph nodes?

Lymph nodes are small bean shaped structures that are all over the body including near the breast. They are responsible for filtering the lymph fluid as it passes through them. The lymph nodes in the armpit drain the lymphatic fluid from the breast and arm.

It is important to know if there are cancer cells in the lymph nodes in the armpit and how many lymph nodes are affected. This helps the doctors work out the ​stage​ of your cancer and plan the best treatment for you.

Find out about staging breast cancer

What happens after a sentinel node biopsy?

If the lymph nodes do not contain cancer cells, you won’t need to have any more nodes taken out.

If cancer cells are in the sentinel nodes, you have an axillary lymph node dissection or axillary clearance. This is a second operation that you generally have about 2 weeks after you get the results.

Radiotherapy instead of surgery

Radiotherapy means the use of radiation, usually x-rays, to treat cancer. Some people have radiotherapy to the armpit to destroy any remaining cancer cells instead of surgery.

Read about radiotherapy for breast cancer

Getting the results during surgery

In some hospitals, the surgeon gets the results of the sentinel lymph node biopsy during the operation. This is called an intra operative assessment. They can remove the rest of the nodes (axillary lymph node dissection) if necessary. You then avoid having a second operation. This type of testing is called one step nucleic acid amplification (OSNA).

Your surgeon will explain this to you before your operation, so you know what to expect.

Removing most or all of the lymph nodes

You might have this operation as part of your breast surgery or as a separate operation.

You have a general anaesthetic for this operation. You will be asleep the whole time.

The surgeon makes a small cut in your armpit to remove the lymph nodes. Generally, they remove between 10 and 15 lymph nodes. But the number of nodes in the armpit varies from person to person.

The surgeon sends the lymph nodes to the laboratory to check them for cancer cells. You get the results at your follow up appointment.

What happens after surgery?

After the operation, you usually wake up in the recovery room before moving back to your ward or day unit. Find out what else to expect immediately after surgery.

What happens after surgery?

Follow up after surgery

You have follow up appointments to check your recovery and sort out any problems. They are also your opportunity to raise any concerns you have.

You usually see your surgeon one to two weeks after your operation. They examine you and check your wound is healing well.

Your surgeon will explain the results of your surgery and talk about any further treatment you might need.

You'll have contact details of your breast care nurse or the ward if you need to contact someone before your follow up.

Problems after removing lymph nodes

There are some possible problems after having surgery to the lymph nodes in your axilla. Not everyone will have these but there is a bigger risk if you have an axillary dissection. Some of these problems include:

A swollen arm or hand

You are at risk of long term swelling (lymphoedema) in your hand and arm after surgery to remove your lymph nodes in the armpit. This is swelling caused by lymph fluid that can't drain away. It can happen any time after surgery and radiotherapy to your armpit. 

Not everyone will get this and it is less likely to happen if you only have a few nodes removed. But it is very important to speak to your specialist nurse or surgeon if you think your arm or hand may be swollen. 

Unfortunately, once you have lymphoedema it can’t be cured. But early treatment can help to control it. Your nurse will talk to you about ways of preventing lymphoedema.

Find out about lymphoedema after breast cancer treatment

Shoulder stiffness

Your shoulder might become stiff and painful after breast surgery to the lymph nodes. Your nurse or a physiotherapist will show you exercises to do after your operation to help improve movement in the shoulder.

Find out about exercise after breast surgery

Fluid collecting around the operation site (seroma)

Sometimes fluid collects near the wound and around the armpit. This might happen after your nurse removes the wound drain if you have one.

It can cause:

• swelling

• pain

• an increased risk of infection

The fluid normally goes away on its own within a few weeks. 

Your nurse or doctor can drain the fluid with a needle and syringe if the seroma is painful. Sometimes the fluid can build up again after being drained. 

Tell your doctor or nurse if you think a seroma is developing.

Wound infection

Tell your doctor or nurse if your wound:

• looks red and swollen

• feels warm

• is painful

• leaks fluid (discharge)

These are signs of infection. You may also feel unwell and have a temperature.

If you have an infection, your doctor will give you antibiotics. You might need to stay in longer or go back into hospital if you need antibiotics through a drip.

Nerve pain

You might have numbness, tingling or a shooting pain in your armpit, upper arm, shoulder or chest wall. This is due to damage to the nerves during surgery. The nerves usually repair themselves, but it can take many weeks or months.

Your doctor or nurse can give you medicines to help with nerve pain.

Scar tissue in the armpit (cording)

Some women develop scar tissue in the armpit after lymph node removal. The connective tissues in the armpit get inflamed, which forms one or more tight bands. This usually happens within the first few weeks or months after the operation.

The scar tissue is called cording or banding or axillary web syndrome. It can feel something like a guitar string. It can extend down the arm past the elbow, possibly as far as the wrist or thumb.

Cording is harmless but can be painful and can limit your arm movement. Massaging the area regularly can help. Tell your breast care nurse if you develop cording. They can refer you to a physiotherapist. They can show you how to massage the area and teach you stretching exercises. It usually gets better within a few months. Taking anti inflammatory painkillers may also help. Speak to your nurse or doctor about taking these. 

Find out what happens after surgery