EASTERN SUBURBS BREAST SURGERY
Axillary Surgery
What is Axillary Surgery?
The axilla - commonly known as the armpit - contains a network of lymph nodes that form part of the body’s immune and drainage system. In breast cancer, these lymph nodes are important because they are one of the first places to which cancer cells can spread beyond the breast. Assessing and, where necessary, treating the axillary lymph nodes is therefore an important part of breast cancer management for many patients.
At Eastern Suburbs Breast Centre, axillary surgery is carefully planned as part of your overall treatment. Your surgeon will explain clearly whether axillary surgery is recommended for you, what it involves, and what to expect.
Types of Axillary Surgery
Sentinel Lymph Node Biopsy
For most patients, the first step in assessing the axilla is a sentinel lymph node biopsy. This is a more limited procedure that involves identifying and removing only the first one to three lymph nodes that drain the breast — the nodes most likely to contain cancer cells if the cancer has spread. If these nodes are clear, no further axillary surgery is usually required.
Sentinel lymph node biopsy is described in more detail on our Lumpectomy and Mastectomy pages.
Axillary Lymph Node Dissection (Axillary Clearance)
Some patients require a more extensive operation — an axillary lymph node dissection, also called an axillary clearance. This involves removal of most of the lymph nodes in the axilla. This may be recommended if:
Cancer has been found in the lymph nodes at the time of your initial diagnosis, or
Your sentinel lymph node biopsy has shown cancer cells in the nodes
The number of lymph nodes in the axilla varies considerably from person to person — typically anywhere between 10 and 40 nodes. Your surgeon will discuss the findings and what they mean for your treatment at your consultation.
The Operation
Axillary lymph node dissection is performed under general anaesthetic and takes approximately one hour. It may be performed at the same time as your breast surgery or, in some cases, as a separate procedure.
A drain is placed in the axilla at the time of surgery to prevent fluid accumulating at the operation site. This drain will remain in place when you go home and is typically removed at a wound review appointment up to two weeks after surgery. Your breast care nurse will ensure you are confident managing your drain before you are discharged.
Most patients stay in hospital for one to two nights following axillary lymph node dissection.
Physiotherapy and Shoulder Rehabilitation
Physiotherapy is an essential and important part of recovery following axillary lymph node dissection — not an optional add-on. You will be seen by a physiotherapist during your hospital stay, who will guide you through a programme of shoulder and arm exercises to begin before you go home.
Continuing these exercises consistently after discharge is vital. They help restore your shoulder range of motion, reduce stiffness, and support your recovery. Your physiotherapist will provide you with a home exercise programme and will arrange follow-up as needed.
Please take your rehabilitation programme seriously — it makes a real difference to how well and how quickly you recover.
Risks & Complications
Your surgeon will discuss the risks of axillary lymph node dissection with you in detail at your consultation. These include:
General surgical risks
Bleeding or haematoma
Infection
Wound healing difficulties
Anaesthetic risks
Blood clots (deep vein thrombosis)
Risks specific to axillary surgery
Lymphoedema — swelling of the arm, hand, or breast caused by disruption to the lymphatic drainage system. This is the most significant long-term risk of axillary clearance and can be permanent. Your breast care nurse and physiotherapist will advise you on how to reduce your risk and what to watch for
Seroma (fluid collection), which may require drainage in the rooms
Numbness or altered sensation in the inner arm and axilla, caused by stretching or division of small sensory nerves — this is very common and often permanent
Reduced shoulder movement and stiffness, particularly without adequate physiotherapy
Nerve injury — in rare cases, nerves supplying the muscles of the arm or chest wall may be affected
Lymphoedema — What You Need to Know
Lymphoedema is a condition in which fluid accumulates in the arm or hand due to disruption of the lymphatic system following axillary surgery. It can develop shortly after surgery or months to years later, and it can be a chronic condition requiring long-term management.
While not every patient who has an axillary clearance will develop lymphoedema, the risk is significant and lifelong. There are steps you can take to reduce your risk, including:
Avoiding blood pressure cuffs, blood tests, and injections in the affected arm where possible
Protecting the arm from cuts, burns, and infection
Avoiding prolonged heat and heavy repetitive activity with the affected arm
Wearing a compression sleeve during air travel if advised
Maintaining a healthy weight
If you notice any swelling, heaviness, or tightness in your arm, hand, or fingers, please contact our rooms promptly. Early intervention gives the best outcomes. Our team can refer you to a specialist lymphoedema physiotherapist for assessment and treatment.
Your Recovery
Hospital stay: One to two nights
Drain: In place for up to two weeks; removed at a wound review appointment
Shoulder exercises: Begin in hospital and continue at home — this is essential
Time off work: Will depend on the nature of your work and the extent of your surgery — your surgeon will advise you
Bathing and swimming: Avoid soaking in a bath or swimming until cleared by your surgeon
Heavy lifting and strenuous exercise: Avoid until your surgeon advises it is safe to resume
This page is intended as general patient information only and does not replace individualised medical advice. Please discuss your specific situation with your treating surgeon.
Private Expertise, Coordinated Care
All five of our surgeons hold appointments at two of Sydney’s leading public teaching hospitals. This keeps us at the forefront of evidence-based practice, clinical research, and multidisciplinary care. We bring that same standard of excellence to our private practice, with operating privileges across leading private hospitals throughout the Eastern Suburbs. Whatever your circumstances, you have access to a team working at the highest level.