Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1202–1208 | Cite as

Risk Factors Associated with Breast Lymphedema

  • Judy C. Boughey
  • Tanya L. Hoskin
  • Andrea L. Cheville
  • Joyce Miller
  • Margie D. Loprinzi
  • Kristine M. Thomsen
  • Shaun Maloney
  • Larry M. Baddour
  • Amy C. Degnim
Breast Oncology



The development of breast lymphedema (BLE) after breast/axillary surgery is poorly characterized. We prospectively evaluated clinical and surgical factors associated with development of BLE.


Patients undergoing unilateral breast-conserving surgery were prospectively enrolled preoperatively and followed for development of BLE. To augment the number of patients with BLE for evaluation of risk factors, postoperative patients identified in the clinic with signs and symptoms of BLE were also enrolled. Logistic regression with Firth’s penalized likelihood bias-reduction method was used for univariate and multivariate analysis.


Of 144 women, 124 were enrolled preoperatively (38 of whom developed BLE), and 20 women with BLE were enrolled postoperatively. Any type of axillary surgery was the strongest factor associated with BLE (odds ratio, 134; 95 % confidence interval, 18 to >1,000). All 58 BLE events occurred in women with axillary surgery as compared with no events in the 46 patients without axillary surgery (p < 0.0001). Among 98 women who underwent axillary surgery, BLE did not occur more often after axillary lymph node dissection versus sentinel lymph node biopsy (p = 0.38) and was not associated with total number of nodes removed (p = 0.52). In multivariate analysis, factors associated with the development of BLE in the axillary surgery subgroup included baseline BMI (p = 0.004), incision location (p = 0.009), and prior surgical biopsy (p = 0.01).


Risk of BLE is primarily related to performance of any axillary surgery but not the extent of axillary surgery or number of lymph nodes removed. Other factors associated with BLE were increased body mass index, incision location, and prior surgical excisional biopsy.


Sentinel Lymph Node Biopsy Lymphedema Axillary Lymph Node Dissection Axillary Surgery Outer Quadrant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This publication was made possible by the Mayo Clinic CTSA through Grant UL1RR024150 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Amy C. Degnim was also supported for this project by the CA90628-08 Paul Calabresi Award for Clinical-Translational Research (K12) via the Mayo Clinic Cancer Center. We also thank the women who volunteered in this study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Judy C. Boughey
    • 1
  • Tanya L. Hoskin
    • 2
  • Andrea L. Cheville
    • 3
  • Joyce Miller
    • 1
  • Margie D. Loprinzi
    • 1
  • Kristine M. Thomsen
    • 2
  • Shaun Maloney
    • 2
  • Larry M. Baddour
    • 4
  • Amy C. Degnim
    • 1
  1. 1.Department of SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA
  3. 3.Department of Physical Medicine and RehabilitationMayo ClinicRochesterUSA
  4. 4.Division of Infectious DiseasesMayo ClinicRochesterUSA

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