Sentinel lymph node biopsy and lymph node removal at Spire Norwich Hospital

If you’ve been diagnosed with breast cancer your main concern will be to beat it, receive the all clear and go back to living your normal, healthy life.

Women with breast cancer often have these procedures as part of their treatment plan. Your doctor will need to know if the cancer has spread to the lymph nodes, including the sentinel (or first) node. These are small organs that are part of your immune system. When suggesting this treatment, your consultant oncologist will consider three objectives for this procedure involving the nodes in your armpit, depending on your circumstances:

• to remove a few for testing
• to conduct a biopsy on the sentinel node
• if previous tests on your lymph nodes have shown they are cancerous, they can all be removed when you have breast surgery or in a separate procedure.

If tests reveal that cancer has spread to the lymph nodes you may require further treatment such as radiotherapy or chemotherapy.

Sentinel node biopsy is also sometimes recommended to patients with skin cancer (melanoma). In this case the nearest sentinel node to the melanoma site will be removed.

You might be anxious to have this procedure done quickly to either bring you peace of mind by receiving an all-clear or to move your treatment forward through it being confirmed.

If you decide to have your treatment with us, you will be looked after by an experienced multi-disciplinary care team.

Our patients are at the heart of what we do and we want you to be in control of your care. To us, that means you can choose the consultant you want to see, and when you want. They'll be with you every step of the way.

All of our consultants are of the highest calibre and benefit from working in our modern, well-equipped hospitals.

Our consultants have high standards to meet, often holding specialist NHS posts and delivering expertise in complex sub-specialty surgeries. Many of our consultants have international reputations for their research in their specialised field.

You will have a formal consultation with a healthcare professional. During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have.

We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.

We've tried to make your experience with us as easy and relaxed as possible.

For more information on visiting hours, our food, what to pack if you're staying with us, parking and all those other important practicalities, please visit our patient information pages.

Our dedicated team will also give you tailored advice to follow in the run up to your visit.

We understand that having any surgery can cause anxiety. Our experienced and caring medical staff will be there to reassure you throughout.

If you are having lymph nodes removed, you’ll have a general anaesthetic which means you'll be asleep during the operation. Your surgeon will make a small cut in your armpit. If tests have confirmed the cancer has spread, he or she will remove all your lymph nodes. Otherwise your surgeon will remove a few for testing.

He or she will close the cut with dissolvable stitches at the end of an operation that usually lasts around 45 minutes.

However, your consultant may wish to specifically remove and test the first (or sentinel) node.

This is a more complex procedure involving two or three stages and can be performed under either general or local anaesthetic. The first two stages of the procedure help your surgeon to locate the sentinel node.

During the first stage - lymphatic mapping - it's possible that your consultant radiologist will inject a small amount of a radioactive isotope into your body around the cancer site. This chemical will drain into your nearby lymph nodes. Your radiologist will use a scanner or special camera to locate the lymph node area and mark this on your skin. This mark will help your surgeon locate the lymph nodes.

The second stage - inter-dermal blue dye injections - involves your surgeon injecting a blue dye into your skin near the tumour. The dye will drain into the lymph nodes after three to ten minutes.

Finally, using the skin markings as guidance, your surgeon will cut through the skin to reach the lymph node area. He or she will follow the blue dye pathway to identify the sentinel lymph node. If you had a radioactive isotope, your surgeon will also look for the isotope in the sentinel node using the special camera. The surgeon then removes the ‘sentinel’ lymph node and any other affected nodes. The wound is then closed with dissolvable stitches.

The operation typically lasts around 30 minutes.

Depending on the scale of your surgery and the technique used, you may have to stay in hospital for up to three days.

After this, you will be taken to your room or comfortable area where you can rest and recuperate until we feel you’re ready to go home. 

Pain relief

You will have some pain, swelling and bruising around the armpit and if a sentinel node was removed from elsewhere, the other operation site. We'll give you pain relief for this while in hospital but over the counter medicines should be sufficient when you go home.

Your recovery

Before you go home, one of our physiotherapists will show you exercises that will help you regain strength and movement in your arm and speed up your recovery.

We'll take off your dressing up to 48 hours after the procedure and the dissolvable stitches will disappear after about a week.

It will take a week or two for you to recover fully.

If you had a sentinel biopsy, the blue dye injected into your body will be flushed out through your urine – which will appear green for a few days.

Looking after you

If you had a biopsy, we’ll discuss with you before your surgery when the results will be available and arrange an appointment to go through them with you.

When you leave we’ll provide you with all the appropriate medication and information. Typically your consultant will want to see you after your treatment to see how you’re doing, a follow up appointment will be made for you before you leave the hospital. This will be shaped by your recovery and any other tests and treatment you are scheduled to have.

On rare occasions, there can be complications following surgery. The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Your consultant will talk to you about the possible risks and complications of having this procedure and how they apply to you.

If you have any questions or concerns, we’re ready to help.

We are committed to delivering excellent individual care and customer service across our network of hospitals, clinics and specialist care centres around the UK. Our dedicated and highly trained team aim to achieve consistently excellent results. For us it's more than just treating patients, it's about looking after people.

Important to note

The treatment described on this page may be adapted to meet your individual needs, so it's important to follow your healthcare professional's advice and raise any questions that you may have with them.