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Surgery to remove lymph nodes

Find out how you have surgery to remove the lymph nodes under the arm for breast cancer and why.

If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast. These lymph nodes drain the lymphatic fluid from the breast and arm.

Diagram showing the network of lymph nodes in around the breast

Your doctor checks these nodes either:

  • before breast cancer surgery
  • during your breast cancer operation (sentinel lymph node biopsy)

If the nodes contain cancer cells

If there are cancer cells in the lymph nodes, a surgeon removes most or all of the lymph nodes under the arm. This is called an axillary lymph node dissection (ALND) or axillary clearance.

They may do this during the same operation as your breast surgery or as a second operation.

Removing the lymph nodes helps to reduce the risk of your cancer coming back. Also, knowing if there are cancer cells in your lymph nodes helps doctors plan treatment after surgery.

Some people will have radiotherapy to the lymph nodes instead of surgery.

Having the 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 each person has varies.

The surgeon sends the lymph nodes to the laboratory. A pathologist checks them for cancer cells. You get the results at your follow up appointment, about 2 weeks after surgery.

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 can happen 6 to 8 weeks after the operation or some months or years later. The scar tissue is called cording or banding or axillary web syndrome. It can feel something like a guitar string.

Cording is harmless but can be uncomfortable and can limit your arm movement. Massaging the area regularly can help. Your nurse or a physiotherapist can teach you how to do this. Other things that can help include stretching exercises, moist heat, and anti-inflammatory painkillers.

Picture showing cording in the armpit

Information and help

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