The finding of positive lymph nodes usually means that additional adjuvant therapy, hormonal or chemotherapy , is required. If the lymph nodes do not contain cancer, the likelihood of distant metastases is lower. Removal of the lymph nodes per se does not make a difference to survival.
    It is now also recognized that axillary lymph nodes are not an effective barrier to tumor spread. The nodes are removed not as a curative measure but mainly to provide information about the risk of recurrence and metastasis and to better define the need for adjuvant therapy. Removing all or some of the lymph nodes in the armpit—called axillary lymph node dissection and sampling , respectively—may be performed with either a separate incision during the primary operation or as a completely separate surgical procedure. Sampling is done in most patients, being omitted only if treatment decisions would not be influenced by the results.