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Axillary Node Sampling/Sentinel Node Biopsy   
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There are approximately 20 lymph glands in the armpit. The lymph glands are the  most common site to which breast cancer spreads. Lymph node sampling or  sentinel node biopsy aim to remove a few lymph glands to check whether any of them are affected by cancer. Any cancer that spreads to the lymph glands under your arm affects the lowest lymph glands first, which is why sampling these lower  lymph glands tells us, with a great degree of accuracy, whether any glands are affected.  
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To help the surgeon find the lymph glands, you are likely to be injected with a blue  dye and also a slightly radioactive fluid at the nipple after being put to sleep. The dye colours the skin for several months and colours your urine for a couple of days.  

The operation is performed through a small cut (incision) in your armpit just below  where hair grows. At the end of the operation the wound is closed with an  deep stitch that does not need to be removed. If all the lymph glands sampled  are clear, you will not require any further treatment to the lymph glands under  your arm. If any contain cancer then it is usual to treat the remaining lymph glands by radiotherapy or further surgery.  

Problems that can occur after axillary node sampling/ Sentinel lymph node biopsy
  • Bleeding- Even though all visible bleeding at the time of the operation is stopped,  bleeding from the edges of breast tissue can occasionally start after the  operation and cause blood to collect in the wound. This is uncommon and  happens in about 1 in every 100 patients. The normal time for this to  develop is within the first 12 hours after the operation. This is the reason your wound is checked following surgery. 
  • Infection: any operation site can become infected. It affects about 4 in  every 100 women after axillary node sampling. If infection is going to  develop, it is evident about a week after surgery. The wound becomes red, swollen, and very tender and there can be a discharge through the wound. 
  • The most common problem after axillary surgery is pain, swelling, and  discomfort under the arm which lasts for a few weeks then settles  gradually. Remember to continue to take painkillers until your arm is no  longer painful to move.      
  • Allergy and staining- The blue dye used to help find the lymph glands can rarely cause  allergic reactions and can stain the skin around nipple for amny months
  • Seroma- The fluid which normally passes through the lymph glands can build up  and cause a swelling. Sometimes this needs to be removed with a  needle and syringe when you come back to the clinic to have your wound  checked. Because this area is numb following surgery, it is usually a painless procedure. 
  • ​Lymphodema- Excess fluid can accumulate in the arms after lymphnode surgery in the armpit. This is unusual (about 2 in 100) when only a few lymphnodes are removed but can be a lifelong problem if it happens. There are exercises, massage and compression garments to control the symptoms of lymphedema, but it can persist.
  • Numbness: there are nerves which pass through the arm pit to the  inner side of the arm. If these are stretched or damaged during removal  of the lymph glands, you can get an area of numbness on the inner side  of the upper arm. If the nerve has just been stretched the numbness  usually recovers, but may take many months to do so. Long term problems with numbness after axillary node sampling is uncommon (less than 5 out of every 100 women).     
  • This operation is usually performed as a day case.
  • Shoulder stiffness: you will be taught a series of exercises after the  operation. It is important to keep your shoulder moving. You might  experience pain and discomfort after the operation and you might  experience some soreness when you move your arm. Do not be afraid to take regular painkillers after the operation as this will make it less painful and allow you to move your shoulder freely.