Lymph Node Surgery

Most women who undergo surgery for invasive breast cancer also undergo lymph node surgery. There are some exceptions for older women or those with significant medical ailments. Lymph node surgery is primarily a tool to help stage the breast cancer which gives us insight into a patient’s prognosis and helps guide additional treatment decisions with regards to chemotherapy and radiation therapy. In the past 30 years or so, lymph node surgery has become less invasive and just a few lymph nodes now can often be removed to accurately stage most breast cancer.

Who is a good candidate?

Most women with invasive breast cancer undergoing surgery require lymph node surgery.  We can sometimes avoid lymph node surgery in patients older than 70 or those who have other significant medical problems.  Most women with non-invasive breast cancer do not require lymph node surgery, but it is recommended in these patients who undergo mastectomy as there is a significant percentage of these women who end up having invasive disease on final pathology.  These women would then need lymph node assessment but there is no reliable way to assess this after a mastectomy is performed.

Consultation and Procedure

During your consultation, Dr. Schwartz will evaluate your case and decide if you need lymph node assessment.

Dr. Schwartz performs less invasive sentinel nodes surgery (this is the first lymph node cancer would appear in if the cancer had begun to spread from the breast) to evaluate your axillary lymph nodes during surgery. This involves injection of a harmless radioactive tracer or blue dye before surgery which allows Dr. Schwartz to remove just a few specific “sentinel” nodes instead of all the lymph nodes (axillary dissection) resulting in less pain and neuropathy and significantly reduced risk of lymphedema.

Even if you had a positive lymph biopsied before surgery, Dr. Schwartz can specifically remove this lymph node and a few additional ones and still avoid removing all your Lymph Nodes if the additional lymph nodes removed are cancer free. This is termed a “targeted axillary dissection” and can be performed before or after chemotherapy is administered.  When there is significant disease in the axilla, Dr. Schwartz may often need to remove all the lymph nodes (“axillary dissection”) which results in a much higher rate of lymphedema, neuropathy and pain.  When just a few nodes are removed, the incision is simply closed, however when a more extensive  lymph node dissection is required, a drain is placed for several days to insure there is no fluid build-up .

Recover and Results

Sentinel lymph node biopsy, which removes just a few lymph nodes,  has a quick recovery and there is no drain placed that requires removal. Patients may have some numbness and tingling under their arms which may last a few months.  They can resume normal activities quickly, usually within a week.  On the other hand, the recovery from a complete lymph node removal (“axillary dissection”) has a longer recovery, with a more significant risk of lymphedema, neuropathy and pain.  Drains are typically removed approximately 10 days after surgery.  Patients who undergo axillary dissection, especially coupled with radiation therapy have a higher risk of lymphedema than others.  They also experience more significant pain and neuropathy that tends to persist for a longer period of time.

Pathology results from sentinel lymph node biopsy or axillary dissection are typically ready in three to seven days.  Dr. Schwartz will discuss these results with you and their implications for additional treatments you might need.  He will also refer you to the medical and radiation oncologists who will use this information to guide your treatment planning.


Dr. Schwartz is dedicated exclusively to breast surgery and reconstruction, and he has devoted his life to perfecting the appearance of women diagnosed with breast cancer. As a cancer survivor himself, Dr. Schwartz is known for his genuine compassion and unsurpassed commitment to providing the best surgical care tailored to each patient’s individual needs and desires. His innovative procedures and techniques allow him to offer his patients the widest range of surgical options available anywhere.