I have just recently had a lumpectomy for malignant breast cancer. The doctor thinks he got it all. I'm scheduled to have lymph nodes removed in a week. How do they know how many to remove? It seems like there should be some kind of test. Can you explain exactly what they do in this procedure?

--D.

I am not a breast surgeon (here in the United States, gynecologists do not do breast surgery; general surgeons and breast surgeons do), but I can give you the basics. Your surgeon should be able to sit down with you and explain exactly what he is going to do and why -- that's part of the informed consent process.

Now that you have been diagnosed with breast cancer, it is important to make sure it hasn't spread into the nearby lymph nodes already; if it has not spread, your prognosis is excellent and you may not need to have further therapy. (Usually after a lumpectomy, radiation to that breast is recommended to ensure that any stray cancer cells are treated.) If there are positive lymph nodes, you may need to have chemotherapy as well. The lymph nodes of interest are the ones under your arm, the axillary nodes.

In general, your surgeon will make a small incision in your armpit. Through that incision he will "dissect," or remove, any lymph nodes that feel enlarged or abnormally hard. If everything feels normal, he will remove a chain of a few nodes anyway so that they may be examined for any microscopic evidence of cancer. Bleeding will be controlled and the small incision will be closed. Sometimes a drain is left in if it's still a bit oozy at the end -- you'll need to ask your doctor about the possibility of a drain.

In every situation involving surgery the best person to talk to is the doctor who will be performing that surgery. No surgeon of any specialty should be too busy to answer your questions.