SNB versus ALND?

It might be helpful to know what your hormonal receptor/Her2 status is.  I had SNB accompanying my BMX and had 20 IST in the SNB.  Because I was strongly Her2+ both my forward-thinking BS and MO both insisted that I have ALND, due to the aggressiveness of the type of cancer.  My BS is not a knee-jerk reactionary who insists on ALND, he was actually one of the pioneers of SNB and sentinel mapping.  I had an unusual situation in that further up the chain I had a .5cm node, which surprised everyone because it was never seen on mammo/US/MRI prior to BMX.  Had I not had that surgically removed it would have been akin to leaving a stage 1 breast lump in place.  My BS, who maintains a 25 year database of all of his patients, felt that with chemo and radiation I would have had a 60% chance of eradicating the cancer in that node if I had relied on chemo and radiation only.  The difficulty in making a decision in your case is clouded by neo-adjuvant chemo, and no confirmed biopsy of cancer in those nodes.  I have a TN friend who was having neo-adjuvant chemo and  I urged her to have a SNB done when her port was placed so that she would be fully informed and properly staged.  I don't know why more surgeons don't recommend this for those who will undergo neo-adjuvant chemo, it would sure help in situations like yours.  Wishing you the best!

mgcf - that is a standard SNB approach.  I was unusual in that my sentinel (only one lit up on the cancer side, two on the other side - I had bi-lat SNB) was declared clear in the OR so no more nodes were removed.  The pathologist only discovered the 20 IST in the lab on the more in-depth slice and dice after surgery.  My ALND was done five weeks later and the second positive, much larger, node was discovered then.  With a TN dx, or being treated as such, I would want to be as sure as possible too - it is nerve wracking, right?

MGCF and Lou10, this article from the main Breastcancer.org site's Research News section sounds as though it may be the study you're thinking of:

Radiation to Axillary Lymph Nodes Causes Less Lymphedema Than Surgery

• The Mods

MGCF - It was alarming at the time, but it was confined to the time period when I received chemo - a combination reaction to Taxotere and the steroids I was given.  All is well now, don't worry.  That picture was taken last year, a year after finishing active treatment - thank you for the compliment!  I actually started a food sensitivity and elimination diet at the beginning of the year and my lymphedema was vastly improved by it, as well as my aromatase inhibitor induced joint pain. 

Mods, thanks for posting that research. 

MGCF, in my case, it was earlier (2011) research. If believe the first and pivotal study was one published in JAMA called "Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis" (Feb 9, 2011--Vol 305, No 6, pp 569 - 575). Then there was a large Canadian-led study, on the effects of radiation to the lymph nodes, that was reported at the annual meeting of ASCO a few months later. I don't have a reference to that, just a news release from the Canadian Cancer Society on June 4, 2011, called "Practice-changing cancer trial shows additional radiation decreases cancer recurrence". I'm pretty sure those were the two studies that affected my treatment, but obviously there have been more since. Best wishes.