I am cancer doctor.
with most mastectomy, most surgeons will do a standard axillary lymph node dissection of level 1 and 2 of the axilla. you can ask what your surgeon will do.
if there is no evidence of cancer spread to the arm pit, your surgeon may just decide to do a sentinel lymph node dissection of the axilla
if there is large amounts of cancer in the axilla seen on the MRI scan, he may decide to do a full axillary lymph node dissection to remove levels 1-3 of the axilla.
many factors go into the decision if you need additional radiation therapy or chemotherapy.
for chemotherapy, you have to have substantial systemic recurrence risk which would be brought down by chemotherapy.
if you have a large primary tumor or many lymph nodes involved, or high oncotype score or ER negative hormone status or her-2/neu overexpression needing biological herceptin therapy, these are often indicators that you also need systemic chemotherapy
Let me know if you have other questions.
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