When someone is diagnosed with breast cancer, one of the most important questions doctors need to answer is whether the cancer has spread to the lymph nodes in the armpit (called the axilla). This helps guide treatment decisions and ensures patients receive the right combination of surgery, radiation, chemotherapy, or hormone therapy.
In this blog, we’ll break down what axillary surgery means, why it matters, how it has evolved, and what new approaches are making treatment safer and more personalized.
What Is Axillary Surgery?
Axillary surgery refers to procedures that examine or remove the lymph nodes located in the armpit. Lymph nodes act like “filters” in the body — if breast cancer spreads, it often goes to these nodes first.
The main goals of axillary surgery are:
- To check if cancer cells are present in the lymph nodes.
- To determine how far the cancer has spread.
- To help plan further treatment such as chemotherapy or radiation.
Traditionally, axillary surgery involved removing a large number of lymph nodes, but today, the approach is much more precise and less invasive.
How Has Axillary Surgery Changed Over Time?
1. Less Surgery, Same Safety
In the past, Axillary Lymph Node Dissection (ALND) was the standard approach. It meant removing 10–30 lymph nodes from the armpit. While effective, this surgery had long-term side effects such as:
- Arm swelling (lymphedema)
- Reduced shoulder movement
- Numbness or tingling
Now, doctors often use Sentinel Lymph Node Biopsy (SLNB). This is a much smaller surgery where only 1–3 “sentinel nodes” (the first nodes where cancer would spread) are removed.
Studies show that SLNB is just as safe as ALND for many women and dramatically reduces complications.
2. Avoiding Surgery in Older Women
Research has shown that women aged 70 and above with early-stage, hormone receptor-positive breast cancer may not need axillary surgery at all.
If they are already receiving hormone therapy (like tamoxifen or aromatase inhibitors), skipping surgery does not affect survival. This is a major shift in breast cancer care, allowing elderly patients to avoid unnecessary procedures.
What If Cancer Is Found in the Nodes?
Traditionally, if even one lymph node contained cancer, doctors would remove more through ALND. Today, that thinking has changed.
- If only 1–2 nodes are affected, many patients can skip further surgery.
- Instead, radiation therapy can control the disease in the axilla.
This approach is supported by clinical trials showing no difference in survival, but a much lower risk of lymphedema.
After Chemotherapy: A New Approach
For some patients, chemotherapy is given before surgery to shrink the tumor. This is called neoadjuvant chemotherapy.
In these cases, a new technique called Targeted Axillary Dissection (TAD) is used:
- Before chemotherapy, doctors place a small marker in the cancerous lymph node.
- After treatment, that marked node is surgically removed and tested.
- If it is cancer-free, additional surgery may not be necessary.
TAD avoids unnecessary removal of many lymph nodes while still giving accurate information about the cancer.
Preventing Arm Swelling (Lymphedema)
One of the biggest fears patients have after axillary surgery is lymphedema, or swelling of the arm due to blocked lymph fluid.
Fortunately, new surgical techniques are helping reduce this risk:
- LYMPHA and SLYMPHA Procedures – During axillary surgery, surgeons reconnect lymphatic vessels to nearby veins. This allows lymph fluid to keep draining normally.
- Early studies show these techniques greatly lower the risk of arm swelling and improve quality of life.
Why These Changes Matter
Modern axillary surgery is not just about removing nodes — it’s about personalizing treatment.
Benefits include:
- Less pain after surgery
- Faster recovery
- Lower risk of lymphedema
- Tailored decisions based on age, tumor type, and response to therapy
This shift reflects a larger trend in breast cancer care: doing only as much treatment as necessary, and no more.
Axillary Surgery Options at a Glance
| Surgery Type | What It Involves | Who It’s For | Risks |
| ALND (Axillary Lymph Node Dissection) | Removes 10–30 nodes | When multiple nodes are affected or SLNB is not possible | High risk of lymphedema, pain |
| SLNB (Sentinel Lymph Node Biopsy) | Removes 1–3 key nodes | Most early-stage patients | Minimal swelling, safer recovery |
| TAD (Targeted Axillary Dissection) | Removes marked node after chemo | Patients who had chemotherapy first | Lower side effects, very accurate |
| No Surgery | No nodes removed | Selected older women with hormone-positive cancer | None |
Role of Radiation Therapy in Axillary Treatment
Radiation therapy now plays a larger role in controlling cancer in the armpit. For patients with limited lymph node involvement, radiation can be just as effective as surgery in preventing recurrence.
This means fewer patients need aggressive surgical procedures, and outcomes are still excellent.
Key Takeaways
- Axillary surgery in breast cancer has changed dramatically.
- Most women today have smaller, safer procedures instead of major surgeries.
- Sentinel Lymph Node Biopsy (SLNB) has replaced full dissection in many cases.
- Older women with hormone-sensitive cancer may not need lymph node surgery at all.
- Radiation therapy and targeted approaches like TAD are making treatment even more precise.
- New surgical techniques are reducing the risk of lymphedema.
Final Words
Axillary surgery used to mean extensive, painful operations with lifelong side effects. Today, it represents a much more patient-friendly, personalized, and precise approach to breast cancer care.
If you or a loved one is facing breast cancer surgery, don’t hesitate to ask your doctor about the latest options — because less can truly be more when it comes to treatment.
