Once breast cancer has been diagnosed, it is vitally important to ascertain whether it has spread to the nearby lymph nodes in the armpit as this will guide the oncologists with their recommendations for further treatment. Pre-operatively, patients will receive axillary imaging in the form of a dedicated ultrasound by consultant radiologist. Depending on the outcome of this scan and any biopsies that may be required, the following treatments may be recommended to you
Sentinel node biopsy – This procedure is reserved for women who’s pre-operative imaging has not identified any cancer within the armpit, and involves the surgical removal of the first (or ‘sentinel’) lymph node within the armpit that drains the breast on that side. This is then analysed under the microscope to see if cancer cells are present. This procedure involves a pre-operative injection to identify the ‘sentinel’ node which Mr Kenny will discuss with you in further detail.
Axillary clearance – This is offered to women whose pre-operative investigations have identified cancer within the armpit, or may be offered to women whose ‘sentinel node biopsy’ has returned a positive result. It involves removal of all of the fat and lymph nodes from within the armpit on the affected side.
Targeted axillary dissection – For women whom have undergone chemotherapy before surgery, and imaging has shown a good response within the armpit, a ‘targeted axillary dissection’ may be offered whereby the previously identified positive lymph node as well as ideally at least 3 other nodes are removed for assessment.
Axillary exploration – For women who have previously undergone an axillary node clearance and have unfortunately suffered a recurrence within the same breast, an axillary exploration may be recommended which involves a further look into the armpit to identify if any lymph nodes remain for assessment.
It is important to note that all of the above procedures can also be offered in the NHS and if you do suffer with any breast symptoms or have any concerns, ask your General Practitioner to refer you into your local breast unit for assessment.
Frequently Asked Questions
How do I know which axillary surgery I will need?
This depends on the disease found both within the breast and also during clinical and imaging assessment of your armpit prior to surgery. Mr Kenny will guide you through this process and explain the rationale behind which axillary surgery is appropriate for your specific case.
When is axillary surgery performed?
Axillary surgery is performed at the same time as your breast cancer surgery whilst you are asleep under a general anaesthetic. Occasionally a second operation to the axilla may be required depending on the results from your initial surgery and this will be clearly explained by Mr Kenny during your clinic consultation.
What are the risks of axillary surgery?
Aside from the generic risks of performing surgery to the body including bleeding, infection, pain and scaring, specific risks within the axilla include lymphoedema, shoulder pain and discomfort, reduced range of motion of the arm/shoulder, and numbness particularly to the upper, inner arm due to division of the nerves that supply sensation to that region. Occasionally this is temporary but can be a permanent feature.
What is lymphoedema?
Lymphoedema is a swelling of the body tissues due to a build-up of fluid and may occur as a consequence of axillary surgery due to disruption of the lymphatic channels of the armpit. More information can be found via the ‘Breast Cancer Now’ website by clicking here.
What post-operative precautions can I take following axillary surgery?
Mr Kenny and your breast care nurse specialist will strongly encourage you to perform shoulder/arm exercises after surgery, for up to 6 months. This aims to maintain a good range of motion in the shoulder joint which can prevent a frozen shoulder forming after surgery. It also reduces post-operative pain and discomfort, as well as improving fluid accumulation and reducing the likelihood of lymphoedema. More information can be found by clicking here.