Postmastectomy lymphoedema. Treatment and a five-year follow-up study.
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.
Berlin
E
E
Department of Clinical Physiology, Central Hospital, Växjö, Sweden.
Gjöres
J E
JE
Ivarsson
C
C
Palmqvist
I
I
Thagg
G
G
Thulesius
O
O
D000328:Adult; D000368:Aged; D001132:Arm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome