Should I choose axillary dissection?

My situation was a little different in that we had no knowledge of, or reason to believe, there were positive nodes, before the surgery. That was an unpleasant surprise at the time. The surgeon removed 6 nodes, whether that's how many "lit up", or if that's twice as many as had visible cancer, or if they were all stuck together, I have no idea, but that's how many they took. Found out later that a 4th one had microscopic cancer cells. Even knowing all that, none of the oncs recommended taking out any more. The positive nodes got me chemo and radiation. But I was told that nowadays they do not go back in and take out the rest of the lymph nodes, they just radiate them, and it works as well or better, and less chance of triggering lymphedema.

moonblue - there is no clearly correct decision in this situation, the right answer is the one that gives you the most peace and the least angst. I had BMX before chemo and had bi-lat sentinel nodes removed - 2 on the left and 1 on the right. In the OR everything looked clear. Later in the pathology lab, the sentinel on the cancer side was found to contain 20 isolated tumor cells (IST), which is easy to miss in the cursory pathological exam nodes are given during breast surgery. My surgical oncologist insisted that we go back and take the level 1&2 nodes from that side because I was Her2+ and grade 3, even though some surgeons would have declared me "clinically node negative" with only IST. My surgeon was one of the pioneers of SNB and was not a reactionary who routinely removes axillary nodes, his decision was made strictly based on the other parameters of my individual situation and tumor makeup, as it should be - not all patients fit neatly in the box of leaving potentially cancerous nodes in place and just doing radiation. My surgeon's 25 years of experience told him, that for me, it was best to do ALND, and he was right. My oncologist agreed and would not start chemo until I had this surgery. If I was treated today instead of 2010, I would have had neoadjuvent chemo with TCHP, but I would insist on a SNB prior to chemo and I would remove the axillary nodes if the SNB was positive. I had ALND surgery five weeks after my BMX and a large positive node was found that was never seen on any imaging, or felt with any physical exam. I am very happy that I had ALND surgery, even though I do have lymphedema, because I would not have wanted to leave something the same size as a stage 1 breast lump in place under my axilla hoping chemo would eradicate it. One would not do that with a breast tumor, so it seems logical to me not to do it with the axilla - although, this is 20/20 hindsight I wanted to avoid radiation because I have had extensive skin cancers, at least 30 over the last 20 years. Whether you develop lymphedema is a crapshoot - you can have it after a SNB - or removal of any number of nodes, after any breast surgery or rads, but you could also be just fine, it is a roll of the dice. For me, the ALND was based on the same choice as my BMX - I wanted known or suspected cancer surgically removed. Wishing you the best.

I would ask your surgeon whether you need ALND or whether radiation to the breast and nodes would be equally good with lower risk of lymphedema. Depends