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Checking the armpit nodes in breast cancer, and clearing them only when needed, at Apollo Hospital, Bhat, Gandhinagar–Ahmedabad.
Sentinel lymph node biopsy and axillary surgery for breast cancer are carried out by Dr Swapnil Sharma, MS, FMAS, DrNB (Surgical Oncology), Consultant Surgical Oncologist, at Apollo Hospital International Ltd, Bhat, Gandhinagar. Checking the armpit is part of nearly every breast cancer operation; this page explains how it is done and why fewer nodes come out now.
Shah’s Gastro, Cancer & Robotic Surgery Centre. Breast cancer treatment is planned with medical oncology, radiation oncology, radiology and pathology together; every case is discussed at the tumour board.
Dr Swapnil Sharma
MS, FMAS, DrNB (Surgical Oncology)
Consultant Surgical Oncologist, Apollo Bhat
Google rating 5.0, 25 reviews — Apollo, Bhat listing.
Breast cancer, when it spreads, usually reaches the lymph nodes in the armpit first. Whether those nodes carry disease changes the stage and the treatment that follows, so they have to be checked.
The armpit, or axilla, holds a chain of lymph nodes that filter fluid draining from the breast and the arm. Cancer cells that leave the breast tend to settle there before going anywhere else. Knowing whether they have done so guides chemotherapy, radiotherapy to the armpit and chest wall, and sometimes the hormone tablets taken afterwards.
For many years every woman with breast cancer had all the armpit nodes removed, to be sure. That answered the question, but at a real price: a swollen arm, a stiff shoulder and a numb patch under the arm. Most of those women turned out to have clear nodes and gained nothing from the clearance.
The sentinel node biopsy was developed to answer the same question with a much smaller operation. It is now the standard first step for women whose armpit nodes look and feel normal before surgery.
Every woman has an ultrasound of the armpit as part of the breast work-up. If a node looks abnormal, a needle test is done on it.
The armpit decision and the breast decision are separate. Either kind of armpit operation can be combined with breast conservation or with mastectomy.
The marker — a blue dye, a weak radioactive tracer, or both together — is injected into the breast, usually near the nipple. It follows the lymph channels, which is the same path a cancer cell would take, and collects in the first node or nodes it reaches.
Through a short cut in the armpit, the surgeon finds the node that is blue, or that a hand-held probe shows has taken up the tracer. Sometimes there is one sentinel node, sometimes a few. Any other node that feels hard is removed as well.
The nodes go to the pathologist. Where a frozen-section test is used, part of the answer is available while you are still asleep; otherwise the full answer comes with the histopathology report.
The blue dye can tint the urine green-blue for a day and leave a faint blue stain on the breast skin that fades over months. Allergy to the dye is uncommon and is watched for during the anaesthetic.
Sentinel node biopsy removes a few nodes through a small cut, rarely needs a drain, and carries a low risk of arm swelling. Axillary dissection removes the armpit nodes with the fat around them, usually needs a drain, and carries a higher risk of swelling and numbness.
Swipe sideways to see the whole table.
| Sentinel node biopsy | Axillary dissection (clearance) | |
|---|---|---|
| Nodes removed | The first one or few nodes | The armpit nodes with the surrounding fat |
| Who it is for | Armpit normal before surgery | Nodes proven or found to carry significant disease |
| Drain needed | Usually not | Yes |
| Risk of arm swelling later | Low | Higher |
| Numb patch on the inner arm | Uncommon | Common |
| Shoulder stiffness | Uncommon | More likely without exercises |
Finding cancer in a sentinel node does not automatically mean the rest of the armpit must be cleared. What happens next depends on how much disease is found, how many nodes carry it, the breast operation done, and the treatment planned afterwards.
Each of these is discussed with you once the report is in, and the reasons are explained.
Most women recover from an armpit operation without trouble. A few effects are common enough that it helps to know about them in advance, so that they are recognised and not feared.
Tell the clinic about redness, fever, a sudden increase in swelling, or a wound that leaks. These are checked the same day.
Move the shoulder through its full range every day from the start. The physiotherapist shows you the exercises before you go home. A stiff shoulder is easier to prevent than to treat.
On the operated side, clean and cover any cut, scratch or burn early, and see someone if the arm becomes red, hot or suddenly larger. Where there is a choice, blood pressure cuffs and blood tests are better taken from the other arm.
Swelling of the arm, called lymphoedema, can start months or even years later. If it does, it can be treated with massage, compression and exercise. Say so early rather than waiting for the next scheduled visit.
It is the first lymph node the breast drains into. If cancer cells travel to the armpit, that node is where they usually arrive first, so testing it tells you about the rest.
A blue dye, a weak radioactive tracer, or both are injected into the breast before or at the start of surgery. They travel the same path the cancer would. The node that takes up the marker is the one removed and tested.
The remaining armpit nodes are left alone. That is the whole point of the test. It spares most women a bigger operation and the arm problems that can follow it.
It does not always mean the rest must come out. With a small amount of disease in one or two nodes, radiotherapy to the armpit is often used instead of a clearance. Where more disease is found, a full clearance is usually the safer choice. The tumour board decides.
After a sentinel node biopsy the risk of arm swelling is low. After a full armpit clearance it is higher. The exercises you are taught, and care with cuts and burns on that arm, both lower it.
A patch of numbness on the inner upper arm is common after a full clearance, because a small sensory nerve runs through the armpit. It often fades over months. Strength is not affected.
At Apollo Hospital International Ltd, Bhat, Gandhinagar. Consultations are held there as well. Call +91 63555 64601 to fix a time with Dr Swapnil Sharma.
The other parts of the breast service each have their own page.
Swipe sideways to see the whole table.
| Page | What it covers |
|---|---|
| Breast cancer surgery in Ahmedabad | The whole breast service in one place: the operations, the order of treatment, and recovery. |
| Breast conservation surgery (lumpectomy) | Removing the cancer and keeping the breast, followed by radiotherapy. |
| Mastectomy: simple and modified radical | Removing the whole breast, with or without the armpit nodes. |
| Oncoplastic surgery and reconstruction | Reshaping or rebuilding the breast, at the same sitting or later. |
| Robotic-assisted mastectomy: who it suits | A hidden-scar nipple-sparing mastectomy for a small group of selected women. |
| Breast lump: when it needs checking | Most lumps are not cancer. How a lump is assessed, and when to see a surgeon. |
Apollo Hospital International Ltd, Bhat — consultation and surgery
Plot No. 1A, GIDC Bhat, Industrial Estate, Gandhinagar, Gujarat 382428
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Phone: +91 63555 64601 · WhatsApp
Last updated: 3 October 2026. Reviewed by Dr Swapnil Sharma, MS, FMAS, DrNB (Surgical Oncology), Consultant Surgical Oncologist.
This page is for information. It is not a substitute for an examination and a personal opinion.
Bring the mammogram, the ultrasound of the breast and armpit, and the biopsy report to the first visit. Call to fix a time. Call +91 63555 64601 · Ask on WhatsApp
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