Long-Term Management of Breast Cancer-Related Lymphedema after Intensive Decongestive Physiotherapy

  • Stéphane VignesEmail author
  • Raphaël Porcher
  • Maria Arrault
  • Alain Dupuy
Clinical trial



Treatment of lymphedema is based on intensive decongestive physiotherapy followed by a long-term maintenance treatment. We analyzed the factors influencing lymphedema volume during maintenance treatment.


Prospective cohort of 537 patients with secondary arm lymphedema were recruited in a single lymphology unit and followed for 12 months. Lymphedema volume was recorded prior to and at the end of intensive treatment, and at month 6 and month 12 follow-up visits. Multivariate models were fitted to analyze the respective role of the three components of complete decongestive therapy, i.e. manual lymph drainage, low stretch bandage, and elastic sleeve, on lymphedema volume during the 1-year maintenance phase therapy.


Mean volume of lymphedema was 1,054 ± 633 ml prior and 647 ± 351 ml after intensive decongestive physiotherapy. During the 1-year maintenance phase therapy, the mean lymphedema volume slightly increased (84 ml—95% confidence interval [CI]: 56–113). Fifty-two percent of patients had their lymphedema volume increased above 10% from their value at the end of the intensive decongestive physiotherapy treatment phase. Non-compliance to low stretch bandage and elastic sleeve were risk factors for an increased lymphedema after 1-year of maintenance treatment (RR: 1.55 [95% CI: 1.3–1.76]; P < 0.0001 and RR: 1.61 (95% CI: 1.25–1.82); P = 0.002, respectively). Non-compliance to MLD was not a risk factor (RR: 0.99 [95% CI: 0.77–1.2]; P = 0.91).


During maintenance phase after intensive decongestive physiotherapy, compliance to the use of elastic sleeve and low stretch bandage should be required to stabilize lymphedema volume.


Breast cancer Lymphedema Physiotherapy Compliance Elastic garment Low stretch bandage 


  1. 1.
    Meric F, Buchholz TA, Mirza NQ et al (2002) Long-term complications associated with breast-conservation surgery and radiotherapy. Ann Surg Oncol 9:543–549PubMedCrossRefGoogle Scholar
  2. 2.
    Ozaslan C, Kuru B (2004) Lymphedema after treatment of breast cance. Am J Surg 187:69–72PubMedCrossRefGoogle Scholar
  3. 3.
    Clark B, Sitzia J, Harlow W (2005) Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. Q J Med 98:343–348Google Scholar
  4. 4.
    Tobin M, Lacey HJ, Meyer L, Mortimer PS (1993) The psychological morbidity of breast cancer related arm swelling. Cancer 72:3248–3252PubMedCrossRefGoogle Scholar
  5. 5.
    Földi E, Földi M, Clodius L (1989) The lymphedema chaos: a lancet. Ann Plast Surg 22:505–515PubMedCrossRefGoogle Scholar
  6. 6.
    Ko DS, Lerner R, Klose G, Cosimi AB (1998) Effective treatment of lymphedema of the extremities. Arch Surg 133:452–458PubMedCrossRefGoogle Scholar
  7. 7.
    Harris SR, Hugi MR, Olivotto IA, Levine M, Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer (2001) Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. CMAJ 164:191–199Google Scholar
  8. 8.
    International Society of Lymphology (2003) The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology 36:84–91Google Scholar
  9. 9.
    Lennihan R Jr, Mackereth M (1973) Calculating volume changes in a swollen extremity from surface measurements. Am J Surg 126:649–652PubMedCrossRefGoogle Scholar
  10. 10.
    Sitzia J (1995) Volume measurement in lymphoedema treatment: examination of formulae. Eur J Cancer Care 4:11–16CrossRefGoogle Scholar
  11. 11.
    Megens AM, Harris SR, Kim-Sing C, McKenzie DC (2001) Measurement of upper extremity volume in women after axillary dissection for breast cancer. Arch Phys Med Rehabil 82:1639–1644PubMedCrossRefGoogle Scholar
  12. 12.
    Galland C, Auvert JF, Flahault A, Vayssairat M (2002) Why and how post-mastectomy edema should be quantified in patients with breast cancer. Breast Cancer Res Treat 75:87–89PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen SR, Payne DK, Tunkel RS (2001) Lymphedema. Strategies for management. Cancer 92:980–987PubMedCrossRefGoogle Scholar
  14. 14.
    Casley-Smith JR, Casley-Smith JR (1992) Modern treatment of lymphoedema I. Complex physical therapy: the first 200 australian limbs. Australas J Dermatol 33:61–68PubMedCrossRefGoogle Scholar
  15. 15.
    Boris M, Weindorf S, Lasinski B, Boris G (1994) Lymphedema reduction by non-invasive complex lymphedema therapy. Oncology 8:95–106PubMedGoogle Scholar
  16. 16.
    Johansson K, Albertsson M, Ingvar C, Ekdahl C (1999) Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema. Lymphology 32:103–110PubMedGoogle Scholar
  17. 17.
    Szuba A, Cooke JP, Yousuf S, Rockson SG (2000) Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema. Am J Med 109:296–300PubMedCrossRefGoogle Scholar
  18. 18.
    McNeely ML, Magee DJ, Lees AW, Bagnall KM, Haykowsky M, Hanson J (2004) The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Res Treat 86:95–106PubMedCrossRefGoogle Scholar
  19. 19.
    Johansson K, Albertsson M, Ingvar C, Ekdahl C (1999) Effects of compression bandaging with or without manual lymph drainage treatment in patients with postoperative arm lymphedema. Lymphology 32:103–110PubMedGoogle Scholar
  20. 20.
    Andersen L, Hojris I, Erlandsen M, Andersen J (2000) Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage. Acta Oncol 39:399–405PubMedCrossRefGoogle Scholar
  21. 21.
    Badger CM, Peacock JL, Mortimer PS (2000) A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb. Cancer 88:2832–2837PubMedCrossRefGoogle Scholar
  22. 22.
    Mortimer PS (1995) Management lymphedema. Clin Exp Dermatol 20:98–106PubMedCrossRefGoogle Scholar
  23. 23.
    Szuba A, Rockson SG (1997) Lymphedema: anatomy, physiology and pathogenesis. Vasc Med 2:321–326PubMedGoogle Scholar
  24. 24.
    Foldi E (1996) Prevention of dermatolymphangioadenitis by combined physiotherapy of the swollen arm after treatment of breast cancer. Lymphology 29:91–94PubMedGoogle Scholar
  25. 25.
    Passik SD, McDonald MV (1998) Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer 83(suppl 12):2817–2820PubMedCrossRefGoogle Scholar
  26. 26.
    McWayne J, Heiney SP (2005) Psychological and social sequelae of secondary lymphedema. Cancer 104:457–466PubMedCrossRefGoogle Scholar
  27. 27.
    Mirolo BR, Bunce IH, Chapman M et al (1995) Psychosocial benefits of postmastectomy therapy. Cancer Nurs 18:197–205PubMedCrossRefGoogle Scholar
  28. 28.
    Boris M, Weindorf S, Lasinski B (1997) Persistence of lymphedema reduction after noninvasive complex lymphedema therapy. Oncology (Huntingt) 11:99–109 discussion 110, 113–114Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Stéphane Vignes
    • 1
    Email author
  • Raphaël Porcher
    • 2
  • Maria Arrault
    • 1
  • Alain Dupuy
    • 3
  1. 1.Department of LymphologyHôpital Cognacq-JayParisFrance
  2. 2.Department of Biostatistics and Medical Informatics, Hopital Saint-Louis AP-HPUniversité Paris 7ParisFrance
  3. 3.Department of Dermatology 2Hôpital Saint Louis AP-HPParis Cedex 10France

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