Manuel A. Torres-Salichs MD,FACS Surgical Oncology, Breast Surgeon

Edileidis Tarrio, ARNP-BC, OCN





Management of the Axilla

Surgical Treatment Options Breast Cancer

Axillary Node Status:
The lymphatic system plays an important role in your body's mechanism for fighting infections and tumors. The status of the axillary lymph nodes is the most significant prognostic factor in patients with early breast cancer. Accurate assessment of the lymph nodes is important to stage the tumor. It provides information about prognosis and guides the surgeon in dictating the need for further treatment (chemotherapy, radiation therapy or hormonal therapy).

  The breast lymphatics drain into three major lymph node regions. These are the axillary, internal mammary, and supraclavicular lymph nodes.


Axillary Lymph Node Dissection:
Breast cancer cells can migrate and spread through the lymphatic vessels into the lymph nodes located in the underarm (axillary), behind the chest bone (internal mammary), or at the level of the collarbone (supraclavicular). The axillary lymph nodes are removed when cancer cells have spread to these areas. These lymph nodes are looked at under the microscope to detect if cancer cells exist.

  Axillary lymph node dissection refers to the removal of several lymph nodes in the axilla. Arm lymphedema is a complication resulting from the removal of these lymph nodes. The patient may also experience sensory changes in the upper arm.


If cancer cells have spread to the lymph glands there is a higher probability that tumor cells may have spread to other parts of the body.

Guide Therapy:
This information is used to stage the breast cancer and to guide the need for additional (adjuvant) treatment (chemotherapy, hormonal therapy, and radiation therapy).

Improved Local Control:
The removal of the affected lymph nodes will improve the local control of the tumor and may have a positive effect on survival, although the data is not definite.

There are known complications related to this surgical procedure. They include arm and breast lymphedema, sensory changes in the arm, pain syndromes, limited arm range of motion, and frozen shoulder among others.


Sentinel Lymph Node Biopsy


  A dye or radioactive material is injected into the breast to identify the sentinel node. This material will be carried through the lymphatic vessels into the sentinel node(s). The sentinel node(s) is removed and looked under a microscope to identify the presence or absence of cancer cells.


Sentinel lymph node biopsy is a minimally invasive procedure designed to stage the axilla in breast cancer patients who have clinically negative lymph nodes. Sentinel lymph node is defined as the first draining lymph node on the direct lymphatic pathway from the primary tumor site in the affected breast. One or several sentinel lymph nodes may be removed from the axillary region. The sentinel node is identified by injecting either a dye or a small amount of radioactive material into the breast, prior to the surgical procedure. The material is carried into the underarm area by the lymphatic vessels and trapped in the sentinel node. The lymph node with the dye only shows where the sentinel lymph node is located, but not if it may or not contain cancer cells or not. The sentinel lymph node or nodes are identified during surgery and looked under the microscope.

If the sentinel node or nodes are involved with cancer, the surgeon will proceed with an axillary node dissection and remove several additional lymph nodes from the underarm area. If the sentinel lymph node is free of cancer cells there is no need to remove additional lymph nodes (axillary node dissection).

This technique identifies the sentinel node in approximately 92% to 98% of cases. The risk of lymphedema is approximately up to 6%.