Berlin E, Gjores JE, Ivarsson C, Palmqvist I, Thagg G, Thulesius O.
Postmastectomy lymphoedema. Treatment and a five-year follow-up study.
Int Angiol 1999 Dec;18(4):294-8

Department of Clinical Physiology, Central Hospital, Vaxjo, Sweden.

BACKGROUND: Lymphoedema of the arm is a common problem after mastectomy and
radiotherapy of mammary cancer. In a prospective 5-year follow-up study we
investigated the development of arm oedema and the effect of conservative
compression treatment. METHODS: Two hundred and twenty-six patients who had
undergone mastectomy were investigated. Oedema formation was estimated by
recording displaced water volume of both arms preoperatively and six times
post-operatively. One hundred fifty-seven patients (70%) could be followed for
five years. An inter-arm difference of 100 ml or more was defined as oedema.
Three types of treatment were given: (1) Compression with stockings in 28
patients, (2) intermittent compression (Flowtron) in 8 and (3) intermittent
compression (Lympha-Press) and compression sleeves in 19 patients. RESULTS: A
total of 46 patients (20%) developed post-operative oedema, 17 within six months
and 29 one year postoperatively. The average oedema volume was 418 ml. Most
patients with a moderate or severe oedema had irradiation therapy. Severe
lymphoedema (750 ml or more) occurred in patients with irradiation
postoperatively and lymph node engagement. There was no correlation between
patient age and oedema formation. Compression therapy with stockings reduced
oedema in 15 out of 28 patients (54%) and prevented further swelling. Therapy
with stockings and Lympha Press reduced the arm volume in 13 out of 19 patients
(68%). Four out of eight patients treated with Flowtron showed oedema reduction.
In most patients cessation of treatment resulted in relapse of swelling to the
same degree as before. CONCLUSIONS: Compression therapy is beneficial to control
postmastectomy arm swelling. This applies to different modalities and prolonged
periods of treatment are required to check progression. Application of stockings
is the simplest way to treat postoperative oedema. In most cases postoperative
oedema appeared during the first year after surgery and the most severe cases
occurred after irradiation.