Not all the time. Fewer surgeries to remove axillary lymph nodes are currently being performed by surgeons. The risk of lymphedema was higher a few years ago when the recommendations were different, and breast cancer that had spread to the lymph nodes required the removal of every one of them. Adjuvant radiation therapy to the residual lymph nodes has been shown in recent studies to be as effective as axillary lymph node removal at controlling local cancer in some patients with cancer in the lymph nodes. Another method of avoiding axillary lymph node dissection is first to use chemotherapy to reduce the cancer’s size. Fewer lymph nodes may need to be removed if there is a positive response.