When you are diagnosed with breast cancer, one of the first places to check is the lymph nodes under your arm (called the axillary lymph nodes). This is because cancer often travels there first.
During breast cancer surgery, a standard step is to perform a Sentinel Lymph Node Biopsy (SLNB) . This checks the first few nodes where cancer is likely to go.
Traditionally, if those nodes showed signs of cancer, the next step was usually a bigger surgery called an axillary lymph node dissection (ALND). This means removing all of the lymph nodes from under the arm.
As many people know, removing all the nodes can lead to side effects. The most common one is lymphoedema (painful swelling in the arm).
The good news is that in some cases, even if cancer has spread to the nodes, we can now avoid removing all of the lymphnodes under the arm. Instead, we can do a more precise surgery called a Targeted Axillary Dissection (TAD) .
When can we do a Targeted Axillary Dissection?
Chemotherapy before surgery (called neoadjuvant chemotherapy), can shrink or even completely wipe out the cancer in the breast as well as in your lymph nodes.
Studies have shown that when this happens, you do not need to have all of your lymph nodes removed (ALND).
However, to find out if the chemo did its job, we still need to check the nodes. Specifically, we need to remove two things:
- The lymph node that had the clip placed in it (the one we knew had cancer from your biopsy).
- The standard sentinel nodes (SLNB; the first ones cancer travels to).
By removing these specific nodes, we can confirm if the cancer is truly gone—and help you avoid a more extensive surgery.
Why Is This Better for Patients?
TAD offers several advantages over the older method of doing a full Axillary Lymph Node Dissection (ALND), where surgeons would remove many lymphnodes together with the axillary fatty tissue:
1. Less extensive surgery
By removing the node that originally contained cancer, along with the sentinel nodes (the first node that the cancer might spread to), we can get the information we need—without having to remove all of the remaining lymph nodes “just to be safe.”
2. Fewer Side Effects
The biggest risk of ALND is Lymphedema—a painful swelling of the arm caused by fluid buildup because the drainage system has been disturbed. Because TAD removes fewer nodes, the risk of developing lymphedema is significantly lower than with a full dissection.
3. Faster Recovery
Less extensive surgery leads to less pain and a quicker return to your normal activities.
4. Accurate Staging
It provides the most accurate information possible. By checking the specific node that used to have cancer, the oncologist knows exactly how well the chemotherapy worked. If that node is now cancer-free (a “pathologic complete response”), your prognosis is usually excellent.
Who Might Not Be Able to Have TAD?
While Targeted Axillary Dissection (TAD) is a great option for many people, it isn’t right for everyone. In some cases you might still be recommended ALND. This is usually the case with the following situations:1. No Clip Was Placed Before Chemo
If a clip wasn’t placed in the cancerous node during your original biopsy, there is no specific target to aim for after chemo.2. Cancer Has Spread FurtherIf scans or exams show that the cancer has spread to many lymph nodes (or to areas outside the nodes).3. You Didn’t Have Chemo First
TAD is specifically designed for people who had chemotherapy before surgery (neoadjuvant chemo). If you are having surgery first, the standard approach (like sentinel node biopsy or full dissection) is usually used instead.4. Inflammatory Breast Cancer
People with inflammatory breast cancer (a rare and aggressive type) often need more extensive lymph node surgery as part of their standard treatment plan.
Your surgeon will look at your specific situation—your scans, your response to chemo, and your clip placement—to decide if TAD is safe and effective for you. If it isn’t, they will explain why and discuss the best alternative.
Personalised treatment plan
Targeted Axillary Dissection is a modern approach that shows we are now able to offer more personalized, targeted care. It is no longer a “one-size-fits-all” plan.
Whether TAD is safe and effective for you will depend on a few key factors:
- Your scans
- How well you responded to chemotherapy
- Whether biopsy clips were placed and can be located
Drnihalyildirim 