Targeted Axillary Dissection (TAD)

Summary:

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Targeted axillary dissection (TAD) is an advanced, minimally invasive technique used to assess and treat the lymph nodes in breast cancer. It combines the precision of sentinel node biopsy with the selective removal of any previously marked lymph nodes that were known to contain cancer before treatment. This approach ensures accurate staging while preserving healthy lymphatic tissue, significantly reducing the risk of arm swelling (lymphoedema) and improving recovery.

 

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What is Targeted Axillary Dissection?

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In some breast cancer patients, cancer cells are found in the lymph nodes before surgery. These nodes are often treated with neoadjuvant (pre-surgery) chemotherapy, which can eliminate or shrink cancer in the lymph nodes.

To accurately assess whether cancer remains after treatment, a targeted axillary dissection is performed.

 

During diagnosis, any cancer-positive lymph node is marked using a tiny clip or seed (such as Metalic clip or SCOUT® Radar). At the time of surgery, this marked node — along with the sentinel lymph nodes — is carefully located and removed. This dual-target approach provides a complete and precise evaluation of the axilla while avoiding the need for full lymph node dissection.

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Before the Procedure

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• A radiotracer injection is also administered either the day before or on the morning of surgery to identify the sentinel lymph nodes.

• You will meet your surgeon and anaesthetist on the day of surgery to review the plan and ask any questions.

• The marked node is identified using specialised localisation technology (radioactive seed, magnetic marker, or radar reflector) placed under ultrasound or mammographic guidance before surgery.​

• Blue dye may also be used to increase the accuracy of targeted node dissection.

• You’ll arrive fasting, as instructed.

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During the Procedure

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• Anaesthesia:

  The surgery is performed under general anaesthetic, so you will be asleep and pain-free throughout.

• Localisation and Removal:

  Using a hand-held detector, the surgeon identifies both the sentinel nodes and the previously marked node through the same small incision.

  These targeted lymph nodes are carefully removed and sent for microscopic examination.

• Specimen Handling:

  The removed lymph node specimen is X-rayed during surgery to confirm the presence of the clip or radar marker, ensuring the correctly targeted node has been retrieved. After confirmation, the specimen is sent to the laboratory for microscopic analysis to assess whether any cancer cells remain following chemotherapy.

• Closure:

  The incision is closed with dissolvable sutures, and the skin is sealed with surgical glue or steri-strips.

  No drains are usually required.

• Duration:

  The operation takes about 45–60 minutes and is usually performed during the same surgery as your lumpectomy or mastectomy.

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After the Procedure

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• You will recover in the ward and usually go home the same day.

• Mild bruising or tightness under the arm or breast is common and improves within a few days.

• Your dressing is waterproof, and you can shower from the day after surgery.

• Gentle arm and shoulder exercises are encouraged to prevent stiffness.

• Avoid heavy lifting for one week.

• Driving is permitted after your first postoperative review, once your arm movement is comfortable and you are off strong pain medication.

• Pathology results are usually available within 7–10 days and will be discussed at your follow-up visit.

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Lymphatic Care:

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At the Breast & Wellness Centre, our lymphoedema therapist assesses all patients before and after surgery to check for pre-existing lymphatic drainage issues and monitor postoperative recovery.

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Possible Risks and Side Effects

 

 

Targeted axillary dissection is a safe, precise procedure, but possible risks include but not limitted to:

 

• Mild bruising or discomfort

• Temporary numbness or tingling in the upper arm

• Small fluid collection (seroma) — uncommon

• Infection (rare)

• Lymphoedema (arm swelling) — very rare (<5%) because only selected nodes are removed

 

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Benefits of Targeted Axillary Dissection

 

 

• Provides accurate staging with fewer nodes removed

• Avoids full axillary dissection in many patients

• Minimises risk of lymphoedema and shoulder stiffness

• Evaluates treatment response after chemotherapy

• Performed through a single small incision, avoiding a separate axillary scar

• Supported by lymphoedema prevention and early assessment at Breast & Wellness

• Enables faster recovery and excellent cosmetic results

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Key Points

 

 

• Combines sentinel node biopsy with removal of previously marked cancerous nodes

• Reduces the need for full axillary dissection

• Lymphoedema therapist assessment pre- and post-op

• You can shower from the day after surgery

• Driving permitted after your first postoperative review

• Lymphoedema risk <5% with our advanced approach

• Usually a day procedure with rapid recovery