Axillary surgery & Lymph nodes

Sentinel Node Biopsy

During breast cancer treatment it is often important to perform surgery to the armpit (axilla) to check that no cancer cells have spread away from the breast. Mr. Hawkins does this by performing a Sentinel Lymph Node Biopsy (SLNB), which involves removing between one and four lymph nodes from the axilla. 


The sentinel nodes are the first nodes in the armpit that may harbour breast cancer cells and if they are free of cancer then it is very unlikely that the remainder of the axillary nodes contain a significant burden of cancer cells.


Mr. Hawkins frequently performs this procedure in combination with your breast cancer surgery or may perform it as a “stand-alone” procedure particularly prior to immediate breast reconstruction or up-front chemotherapy (neo-adjuvant treatment) to help plan your subsequent individual treatment plan.

He does this using a dual localisation technique that involves a very small dose of a radioactive tracer and some blue dye which is injected into the breast. This then allows him to identify the sentinel nodes in your armpit very precisely as they are detectable with a radioactive probe and become blue in colour.

Sentinel node biopsy is now well established as the gold standard in “staging” the axilla. SLNB helps to reduce the incidence of lymphoedema (arm swelling) and movement restriction that has traditionally often been seen with a more extensive axillary lymph node clearance. Recovery from SLNB is usually very quick with extremely low levels of surgical complications.

Proceeding to Axillary Clearance surgery

Mr. Hawkins routine practice is therefore to only recommend an axillary node clearance of the armpit nodes if there is evidence of significant spread of breast cancer cells to the sentinel lymph nodes or if there is clear evidence of cancer cells in the axillary lymph nodes prior to surgery (this can usually be established with an ultrasound scan and biopsy). During you treatment you will have ample opportunity to discuss this aspect of your treatment further and the implication that the results of a sentinel lymph node biopsy may have for your management and prognosis.


Axillary node clearance aims to remove the majority of the lymph nodes from the armpit and usually involves removing more than 10 nodes. Lymphoedema following axillary clearance affects about 1 in 5 patients, although most of these will only experience minor symptoms. These rates can be higher if radiotherapy is also needed. Axillary clearance surgery also has a higher incidence of movement restriction, numbness and seroma formation.