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Lymphatic drainage in the muscle and subcutis of the arm after breast cancer treatment

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Abstract

Breast cancer-related lymphoedema of the arm (BCRL) results from impaired lymph drainage after axillary surgery. Little is known about lymphatic changes in the arm between surgery and oedema onset. We measured forearm muscle and subcutis lymph drainage in 36 women at 7 and 30 months after surgery by quantitative lymphoscintigraphy. None had BCRL initially but 19% had BCRL by 30 months. At 7 months muscle and subcutis drainage in both arms of BCRL-destined women exceeded that of non-BCRL women (P < 0.01). Muscle lymph drainage always exceeded subcutis drainage (P < 0.0001). Muscle lymph drainage in the ipsilateral arm was unimpaired relative to the contralateral arm. BCRL therefore developed in women with higher peripheral lymph flows. The major lymphatic load was generated by muscle; there was no pre-BCRL lymphatic impairment in the muscle of the ipsilateral arm. We propose that some women have a defined, constitutive predisposition to secondary lymphoedema. Specifically, women with higher filtration rates, and therefore higher lymph flows through the axilla that are closer to the maximum sustainable, are at greater risk of BCRL following axillary trauma, even following removal of 1–2 nodes.

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Acknowledgments

We thank the patients, Mr G. Querci della Rovere (Royal Marsden Hospital, Sutton), Mr A.K. Sharma (St George’s Hospital, London) for access to the patients; Dr R. Allan (St George’s Hospital) for holding the ARSAC certificate; A. Irwin (St George’s Hospital) for physics support; and J. Ballinger (Guy’s Hospital, London) and M. Wilkinson (St George’s Hospital) for radiopharmacy support. Grant support: We thank the Wellcome Trust (grant number 063025 awarded to P.S. Mortimer) and the Frances and Augustus Newman Foundation (equipment grant).

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Authors and Affiliations

  1. Cardiac & Vascular Sciences (Dermatology), St George’s Hospital Medical School, University of London, Cranmer Terrace, London, SW17 0RE, UK

    Anthony W. B. Stanton, Stephanie Modi & Peter S. Mortimer

  2. Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK

    Thomas M. Bennett Britton

  3. Hedley Atkins Breast Unit, Academic Oncology, Guy’s and St Thomas’ Trust, London, SE1 9RT, UK

    Anand D. Purushotham

  4. King’s College London, London, WC2R 2LS, UK

    Anand D. Purushotham

  5. Nuclear Medicine, Royal Sussex County Hospital, Brighton, BN2 5BE, UK

    A. Michael Peters

  6. Basic Medical Sciences (Physiology), St George’s Hospital Medical School, University of London, London, SW17 0RE, UK

    J. Rodney Levick

  7. Skin and Rare Cancers, Royal Marsden Hospital, Sutton, SM2 5PT, UK

    Peter S. Mortimer

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  1. Anthony W. B. Stanton
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  2. Stephanie Modi
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  3. Thomas M. Bennett Britton
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Correspondence to Anthony W. B. Stanton.

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Stanton, A.W.B., Modi, S., Bennett Britton, T.M. et al. Lymphatic drainage in the muscle and subcutis of the arm after breast cancer treatment. Breast Cancer Res Treat 117, 549–557 (2009). https://doi.org/10.1007/s10549-008-0259-z

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  • DOI: https://doi.org/10.1007/s10549-008-0259-z

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