Sentinel lymph node
or axillary dissection

It is the first node in the axilla toward which lymph from the breast is directed. If it is free of tumour cells, the probability that deeper nodes are involved is very low. By removing it alone, we obtain reliable information about the axilla without removing all the nodes — sparing most patients the long-term sequelae of dissection.

In the vast majority of cases, yes. Even when a sentinel node is found to be involved (micrometastasis or one to two macrometastases), dissection can usually be avoided — in favor of radiotherapy extended to all nodal regions (axillary, supraclavicular, internal mammary). This is the major takeaway of the landmark trials of the past fifteen years (ACOSOG Z0011, AMAROS, SENOMAC). Dissection remains indicated when a node is proven involved before surgery, in inflammatory breast cancer, or in case of sentinel node mapping failure in the operating room.

After sentinel node biopsy alone: 5 to 7%. After dissection: 20 to 30%. A few simple precautions help limit this risk. After dissection, a compression sleeve is systematically prescribed and worn for 2 months post-operatively, then in at-risk situations (flights, unusual physical effort). If lymphoedema develops later, the sleeve becomes curative and is worn daily, with lymphatic drainage physiotherapy.

No. The dose used is very low, less than that of a chest CT scan, and eliminated within 24 hours. The injection is quick and painless. No specific precautions are required for your family — including young children or pregnant women.

If patent blue was used in the OR, it is eliminated by the kidneys for 24 to 48 hours — urine may take a blue-green tint, and the breast may stay slightly bluish for a few weeks at the injection site. This is normal and harmless. An alternative, indocyanine green (a fluorescent agent visible under a special OR light), does not cause any lasting discoloration.

It depends on the imaging performed after chemotherapy. If no node looks suspicious any longer on ultrasound or MRI, TAD (Targeted Axillary Dissection) can be performed: the standard sentinel node is harvested together with the node that was originally suspicious — located thanks to a small metallic clip placed by the radiologist before chemotherapy. Conversely, if a node is still suspicious after chemotherapy, dissection is performed directly.

The full result of the node analysis is available 10 to 15 days after surgery. It is combined with the analysis of the tumour itself (size, grade, biological profile) to build the complete treatment strategy. A post-operative consultation is scheduled to walk you through the full report. If a decision has to be made at the multidisciplinary tumour board, it is explained and discussed with you — never imposed.

Yes. The lymphoscintigraphy, the surgical procedure and the node analysis are covered at 100% of the French Social Security base rate, under the long-term illness (ALD) framework for breast cancer. Dr Zeitoun practices in secteur 2 non-OPTAM — supplementary fees apply. A detailed quote is provided before any procedure. Your private insurance may reimburse all or part of these supplementary fees depending on your contract.