I can’t speak specifically to what you are asking other than to say I had multiple lymph nodes removed during the mastectomy nine years ago. They found the cancer in three nodes which kept it from being classified as metastatic BUT what I wanted to tell you is to be mindful of lymphatic branching. It is common and can occur when lymph nodes are removed. Make sure you surgeon puts in a referral for physical therapy and follow up to make sure it goes through. My doctor put it in but somehow it got “lost” (I’m assuming by the insurance company) so I was a bit late to get my PT…but it was super helpful (if uncomfortable) to break up the lymphatic blockage under my arm and help retain my mobility and rotation of my arm.

Linda, please ask surgeon for PT referral to learn ROM exercises and simple massage which can go a long way to prevent tightness and loss of strength and ROM in that arm following surgery. I found swimming was a great exercise during all this, once you're cleared by the doctor. Good luck!

I've had the lymph node dissection surgery. They removed 16 lymph nodes from my armpit, 14 of which had cancer and 2 from my chest that were cancerous. I had lymph node bypass surgery at the same time to reduce my odds of developing lymphodema. It's been almost 2 years now and I have no signs of lymphodema.

You say they found 4 positive lymph nodes and they're going to do a PET scan to check for more. That doesn't make sense to me because there needs to be enough cancer in one location for it to show up on a PET scan. If there's just a few cancer cells in one spot it's not a large enough area for the PET scan to detect. You could very well have other cancerous lymph nodes in your armpit that don't have enough cancer cells to register on a PET scan that will be left behind in your armpit if they don't do a full lymph node dissection and remove all the lymph nodes they can find.

Did your doctor mention if they will be doing lymph bypass surgery along with the dissection? This is basically where they take vessels that connect the lymph nodes that are being removed and reroute them so they can drain excess lymphatic fluid properly and reduce your risk of getting lymphodema from the lymph node removal surgery. If bypass surgery isn't done then the lymphatic fluids that were being circulated and drained through your lymphatic system have nowhere to go other than into your armpit and beyond which is what ups the pre-existing risk of developing lymphodema from lymph node removal and breast cancer surgeries in general.

Another consideration is radiation. Will they be giving you radiation to kill off any remaining cancer that they miss while doing the surgery? With or without a full lymph node dissection odds are good that there will be some cancer cells that are left behind.

Regarding the surgery itself, I found it to be more uncomfortable than the pseudo lumpectomy I was given when my breast cancer returned after having a double mastectomy the 1st time I had cancer. My armpit feels tighter and I have lost more range of motion on that side. I also developed neuropathy in my upper inner arm and elbow, but fortunately about 80% of the neuropathy is gone now since the nerves managed to regenerate after the surgery.

Please ask your doctor about having full lymph node dissection to be sure that as much cancer as possible is removed from your armpit lymph nodes, ask if bypass surgery will be done at the same time to lower risks of developing lymphodema, and if you will be having radiation to kill off any breast cancer cells that were left behind. Good luck, I hope your surgery goes well ❤️

Linda, I highly recommend asking about the available lymphatic bypass surgeries that are now available at the same time the nodes are removed!!! No one mentioned this option to me ever and I have bad Lymphodema now. It never goes away so for me it’s one of the hardest things to deal with after all is done. I found out about the bypass options o. This forum and then I researched them. Only Microsurgeons specialize in them. They work together w your surgeon in the operating room. I do wish I could have explored this option. It is most effective is done at same time not later. Just fyi.

My surgeon has already put in a referral for pt and said I'd be measured before surgery. I've used the same pt gals for my neck and back and will make sure the one that works with the lymphatic system gets the referral.