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First, the doctor cleans the involved breast, chest, and upper arm. The surgeon then makes an incision over the targeted malignancy or around the areola if the tumor is accessible from that site, and cuts out the tumor, along with a small layer of tissue surrounding the tumor. The goal of the surgery is to remove the tumor and marginal tissue while damaging the breast as little as possible. However, the surgeon needs to remove enough testable tissue to determine if the cancer is limited to the tumor itself or if the cancer has spread.

The surgeon may make a separate incision near the underarm to sample or to remove axillary lymph nodes, which are then tested for cancerous cells. The findings of these tests help the doctor determine if the cancer has spread from the breast to other parts of the body. The following are types of surgery that may be used to sample or remove axillary lymph nodes:

• Sentinel node biopsy: This procedure involves surgically removing one to five (or more, in some cases) sentinel lymph nodes from the underarm area. The sentinel lymph node is the first location that cancer cells are likely to spread. If cancer cells are not found in the sentinel node, the other lymph nodes are likely to be cancer free as well. This is a popular alternative to axillary lymph node sampling or axillary lymph node dissection, which involve removing more lymph nodes than sentinel node biopsy. In some cases, removing several lymph nodes can lead to complications in the area such as fluid buildup (lymphedema) or decreased sensation. Sentinel node biopsy allows for limited damage to the nerves and lymphatic system.

• Axillary lymph node sampling or dissection: This surgical procedure involves removing most (from 6-20) of the lymph nodes, which are then tested for cancer cells. Because so many nodes are removed, a drain is placed to prevent lymph fluid from collecting. The drain is usually removed in 5-10 days. Axillary lymph node dissection is associated with several complications, which include long-term pain, limited shoulder motion, lymphedema, numbness, and an increased risk of infection. However, most doctors believe that if you have cancer in some lymph nodes (for instance the sentinel nodes) that it helps determine further treatment to know how many more nodes are cancerous. Axillary node dissections are usually done now only in the situation where one or more lymph nodes contain cancer.

The surgeon then stops the bleeding and irrigates the wound. A drainage tube may be inserted during the surgery and removed later. The wound is usually closed with stitches that will eventually dissolve. Bandages are applied to the site of the surgery.

The entire procedure typically takes one to three hours.

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