What is breast cancer?

Breast cancer is a harmful growth that starts in the glandular tissue of your breast.

Lymph nodes (glands) are small structures which lie along lymph vessels present throughout your body. They help your body deal with infections, but they also become involved in the spread of some cancers.

What is an axillary node clearance?

Axillary node clearance is a procedure to remove all the lymph nodes from the affected armpit.

What are the benefits?

Some lymph nodes in your armpit may appear normal but contain cancer cells. Removing all of the lymph nodes in the armpit gives the best chance of clearing the cancer cells from this area.

The lymph nodes that your surgeon removes will be examined under a microscope to help decide on any further treatment.

Surgery will also help reduce the chance of the cancer cells spreading to other parts of the body.

Are there any alternatives?

Sometimes radiotherapy can be used to treat the lymph nodes in your armpit, instead of removing them.

Your breast-care team may not recommend this procedure, particularly if only a small number of cancer cells are found in the lymph nodes in your armpit.

What will happen if I decide not to have the procedure?

The cancer may not be controlled by other treatments, or the cancer may be controlled at first and then spread in a few months or years. The cancer may also grow and cause swelling of your breast, arm or hand (lymphoedema).

What does the procedure involve?

The procedure is performed under a general anaesthetic and takes about 60 to 90 minutes. It may take a little longer if you have breast surgery at the same time.

Your surgeon will make a cut in your armpit. If you are having a procedure on your breast at the same time, your surgeon may be able to use the same cut.

Your surgeon will remove some or all of the nodes and surrounding fatty tissue in your armpit.

They will close the cut with stitches, sticky strips, clips or glue.

All of the lymph nodes and any breast tissue that your surgeon removed will be examined under a microscope. Your breast-care team will know the results 2 to 4 weeks later.

What complications can happen?

The breast-care team are trained to reduce the risk of complications.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

General complications of any procedure

• Bleeding during or after the procedure.
• Infection of the surgical wound.
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the procedure.

Specific complications of this procedure

• Developing a lump under your wound caused by fluid collecting.
• Developing a lump under your wound caused by blood collecting. You may need another procedure to remove the blood.
• Skin necrosis, where some of the skin at the edge of your wound dies leaving a black area. You may need another procedure to remove the dead skin or a skin graft using skin from another area of your body.
• Stiff shoulder. Treatment for a stiff shoulder may involve physiotherapy, medication and injections.
• Numbness or continued pain around your armpit or the inner part of your arm. Numbness can last for up to 6 months and can sometimes be permanent.
• Swelling of your arm, hand or breast.
• Arm weakness caused by damage to nerves or blood vessels in your arm. This is very rare but can be permanent.
• Infection of the affected arm.

Consequences of this procedure

• pain
• scarring of your skin, which may be unsightly

What happens after the procedure?

You should be able to go home the same day or the day after.

You should be able to build up to normal activities after 2 to 3 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the breast-care team or your GP for advice.

The breast-care team will arrange an appointment after the surgery. The lymph nodes and breast tissue that your surgeon removed will have been examined under a microscope. Your breast-care team will tell you the results and discuss with you any treatment or follow-up care you need.

Summary

The lymph nodes in your armpit can be affected by breast cancer. Axillary node clearance is a procedure to remove your lymph nodes to help treat the cancer and to prevent it from coming back in your armpit.

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