Post Mastectomy Lymphedema—a Prospective Study of Incidence and Risk Factors
- 125 Downloads
The aim of this study is to document the incidence of early lymphedema and study the risk factors influencing post mastectomy lymphedema. It is a prospective cohort study involving 98 adult women who underwent surgery including axillary lymph node dissection for biopsy-proven breast carcinoma. Serial measurements of the arm were taken preoperatively and postoperatively at 3, 6 and 12 months. Lymphedema was diagnosed if there was an increase in girth by more than 2 cm in the concerned limb. All patients received standard lymphedema prevention advice. Risk factors assessed were age, body mass index, comorbid conditions, hypertension, medications, socioeconomic status, upper limb symptoms, laterality of disease, type of surgery, stage of the disease, histopathology, node status, wound complication, receptor status, seroma volume, duration of seroma drainage, radiotherapy, chemotherapy, post radiation skin reaction and post therapy weight gain. The statistical analysis was done using chi-square test with SPSS version 16. The incidence of lymphedema was 23.47%. The univariate analysis showed that prolonged or high volume seroma, taxane-based chemotherapy, radiotherapy to axilla and skin necrosis following radiation were significantly associated with lymphedema. In the multivariate analysis, only post radiation skin necrosis was significant.
KeywordsPost mastectomy lymphedema Breast cancer-related lymphedema Upper limb oedema Arm lymphedema Lymphedema
The authors would like to acknowledge Dr. Jayaprakash Muliyil, Professor, Department of Community Medicine, Christian Medical College, Vellore, for his help in analysing the data.
Compliance with Ethical Standards
This prospective observational cohort study was carried out at the Department of Plastic Surgery and Endocrine Surgery, Christian Medical College (CMC) Hospital, Vellore, from 2011 to 2013. The study was approved by the Institutional Review Board and ethics committee.
Conflict of Interests
The authors declare that they have no conflict of interest.
- 5.Tadych K, Donegan WL (1987) Postmastectomy seromas and wound drainage. Surg Gynecol Obstc 165:483–487Google Scholar
- 6.Bertelli G, Venturini M, Forno G, Machaivello F, Dini D (1992) An analysis of prognostic factors in response to conservative treatment of postmastectomy lymphedema. Surg Gynecol Obstc 175:455–460Google Scholar
- 8.Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G (2001) Prognostic factors of lymphedema after primary treatment of breast carcinoma. Cancer 92(7):1783–1787. https://doi.org/10.1002/1097-0142(20011001)92:7<1783::AID-CNCR1694>3.0.CO;2-G CrossRefGoogle Scholar
- 9.Hinrichs CS, Watroba NL, Rezaishiraz H et al (2004) Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol 11(6):573–580. https://doi.org/10.1245/ASO.2004.04.017
- 10.Deo SVS, Ray S, Rath GK, Shukla NK, Kar M, Asthana S, Raina V (2004) Prevalence and risk factors for development of lymphedema following breast cancer treatment. Ind J Cancer 41(1):8–12Google Scholar
- 12.Guedes Neto HI (1997) Arm edema after treatment for breast cancer. Lymphology 30(1):35–36Google Scholar
- 14.Petrek JA, Heelan MC (1998) Incidence of breast carcinoma-related lymphedema. Cancer 83(12 Suppl American):2776–2781Google Scholar
- 15.Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, Miller LT, DeMichele A, Solin LJ (2009) Lymphedema in breast cancer survivors: incidence, degree, time course, treatment and symptoms. J Clin Oncol 27(3):390–397. https://doi.org/10.1200/JCO.2008.17.9291 CrossRefGoogle Scholar
- 16.Fu MR, Guth AA, Cleland CM, Lima ED, Kayal M, Haber J, Gallup L, Axelrod D (2011) The effects of symptomatic seroma on lymphedema symptoms following breast cancer treatment. Lymphology 44(3):134–143Google Scholar
- 17.Thomson DR, Sadideen H, Furniss D (2013) Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev (10):CD006823. https://doi.org/10.1002/14651858.CD006823.pub2
- 18.Jung SY, Shin KH, Kim M, Chung SH, Lee S, Kang HS, Lee ES, Kwon Y, Lee KS, Park IH, Ro J (2014) Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Res Treat 148(1):91–98. https://doi.org/10.1007/s10549-014-3137-x CrossRefGoogle Scholar
- 21.Liao SF, Lee YL et al (2009) Incidence and risk factors analysis of lymphedema secondary to breast cancer. Tw J Phys Med Rehabil 37(4):217–225Google Scholar
- 22.Moran MS, Haffty BG (2009) Radiation techniques and toxicities for locally advanced breast cancer. Semin Radiat Oncol 19(4):244–255. https://doi.org/10.1016/j.semradonc.2009.05.007
- 26.Rockson SG (1998) Precipitating factors in lymphedema: myths and realities. Cancer 83(S12B):2814–2816. https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12B+<2814::AID-CNCR31>3.0.CO;2-E CrossRefGoogle Scholar
- 28.Rovere GQ, Ahmed I, Singh P, Ashley S, Daniels IR, Mortimer P (2003) Audit of the incidence of arm lymphedema after prophylactic level I/II axillary dissection without division of pectoralis minor muscle. Ann R Coll Surg Engl 85(3):158–161. https://doi.org/10.1308/003588403321661299 CrossRefGoogle Scholar
- 29.Coriddi M, Khansa I, Stephens J, Miller M, Boehmler J, Tiwari P (2015) Analysis of factors contributing to severity of breast cancer-related lymphedema. Ann Plast Surg 74(1):22–25. https://doi.org/10.1097/SAP.0b013e31828d7285