I need some feedback

Hopeful, can you get a second opinion from another surgeon? 

Removal of any number of lymph nodes means that you will have a lifelong risk of lymphedema.  The thing about BMI and fitness is a load of crap - this site is full of slender and fit people with LE, myself included.  That said, how was your positive node tested and why in advance of your surgery?  Was it imaged and thought to be positive so they did a FNA?  I think the option of a SNB during your lumpectomy is pretty reasonable.  If you do a SNB your sentinel should attract the dye and/or tracer, but it is also possible for more than one node to do this, or a clump of nodes in one fat pad - and they will remove them, so you do not escape node removal by doing a SNB.  The first node(s) away from the breast will "light up" whether cancerous or not, so it means that potentially fewer nodes will be removed.  I also see your surgeon's point for some degree of axillary clearance since you already have a known positive node, and nobody knows yet if it was your sentinel that was positive.  You are faced with somewhat of a dilemma.

Hopeful, you're in a wretched place right now, and one that many of us have shared at some point in the past.  There are so many decisions to make, so many factors to be considered, and all of it when you're scared, confused, and overwhelmed.

Every practitioner has his/her own approach to patient care.  Some are arrogant, some are impatient, some are remote, and some jewels connect with us, through the hell of breast cancer treatment, with compassion, understanding, and support.

I know you're angry, as most of us were with a breast cancer diagnosis.  At the same time, breast cancer treatment in 2014, as compared to 100 years ago, is designed to save our lives. 

If I'd been diagnosed with breast cancer in 1914 I would have just died.  I am grateful for the biopsy pathologist, the implanted port I had, the science behind the chemo, the surgeon who removed my breasts, the radiation oncologist who custom-designed my treatments, and the plastic surgeon who spent 12 hours standing next to me on the operating table, working to re-construct my breasts. 

I'M ALIVE.  And I'm grateful.

I just wanted to share my perspective.  You will get to the other side of this mountain.  For me, it was quite a climb, but here I am!  Blessings to you--SBE

all the decisions to make is the hardest Ask a lot of questions and make a decision you can deal with one way or the other. I had 2 lymph nodes positive before surgery and after chemo my surgeon removed 30 , the rest negative. I would always have wondered what IF if it comes back if I didn't remove...... Im "lucky" so far ....no swelling at all. Wearing my wedding rings, flew to Europe this summer without issues , run, play soccer and have horses I care for on my own. But I also know women who suffer with LE 

I had no positive nodes visible on mammogram, two different types of ultrasound, and MRI. However, 1 in 3 sentinal nodes tested positive for a micromet. After two lumpectomies failed to clear all the DCIS surrounding my IDC, I struggled with the decision about having ALND with my mastectomy or radiating the area. Since I was hoping to avoid radiation after mastectomy, I went for the ALND hoping that no further nodes were found. I knew that if further nodes were found I would likely have radiation. One more positive node was found, 5mm with no extra capsular extension. I wasn't happy about doing radiation after mastectomy, but I was glad that the positve node was out of my body. I had radiation, but not to the axilla. I wonder if radiation is thought to completely eliminate cancer in a node. If that's what it does, it seems that radiation is a very viable option to treat any positive nodes that may be there. 

I'm just chiming in on this topic to say "Thanks" to this forum and all those who contribute.  Where else in the world (and, frankly, on what other topic) could one get so many different personal stories, offered solely as help to someone who is still confused, about a medical issue?  Doctors know a lot more than we do, but they've often traveled down only one path (their experience, their training - which does vary, let's face it). We know our own bodies, and we've all had such different diagnoses, treatments, and results.  While our docs do their jobs to make money, and are not in the business of training us as medical students, it can still be frustrating to be treated either as stupid or bothersome when we want more information and/or are concerned about things (such as debilitating side effects) the doctor is either not aware of or not concerned about.  They treat the average patient, but few of us are average. They are offended when we do our own research, and some don't like it when we feel the need for a second opinion (taking it as a negative critique on their skills). They may operate on us only once, or pump us full of poisons only once. We're good for their research. But we'll (hopefully) have our one body for a long time and we want to ask questions and make informed decisions.

This is not a rant about doctors. We're lucky to live in a time filled with so much incredible medical knowledge (and I worry we've come to often expect too much), and most of us are lucky to live in "first world" nations so that we can take advantage of this knowledge.

But it's still nice to sit around with a coffee and talk to a thousand "girlfriends" (and guy friends!) to learn about each others' similar stories and hear the real scoop about how these scary findings and procedures went, to learn how things turned out years down the road, and to support each other in our times of need.

Best to y'all. Keep asking questions.  Keep answering.  Keep advocating for yourself.

Hopeful and everyone else,

I just wanted to add another perspective.  I too struggled with the idea of an ALND - my cancer was in my left boob and I am left-handed and active, so I really agonized about the lymphedema risks.  So much so that after I decided to have the full node dissection (15 nodes taken + the positive one we knew about) I immediately went for an LE assessment and physical therapy, which was a great idea.  I wear the funky lymphdiva sleeves too, to stave off any swelling - and I have had none. 

But most importantly, you will see that many of our recon docs are now offering LE surgeries - where (I suppose) they are moving nodes from other parts of your body back into the axilla area in order to alleviate any LE.  It's amazing what they can do nowadays. . .so

Hopeful, as you consider what's best for you, do know that even if you were to suffer from LE, there may be options for treating it that weren't there even 5 years ago.  I had one known positive node from the initial biopsy, and I did neoadjuvant chemo.  After surgery that one node was still positive although it had shrunk quite a bit, and there was encapsulation (cancer critters outside of the node).  But none of the other nodes were positive. 

Hope this helps.