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 w ere investigated. Oedema formation was estimated by recording displaced wat er volume of both arms preoperatively and six times postoperatively. One hu ndred 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 tre atment were given: (1) Compression with stockings in 28 patients, (2) inter mittent compression (Flowtron) in 8 and (3) intermittent compression (Lymph a-Press) and compression sleeves in 19 patients. Results. A total of 46 patients (20%) developed postoperative oedema, 17 wi thin 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 irrad iation postoperatively and lymph node engagement. There was no correlation between patient age and oedema formation. Compression therapy with stocking s reduced oedema in 15 out of 28 patients (54%) and prevented further swell ing. Therapy with stockings and Lympha Press reduced the arm volume in 13 o ut of 19 patients (68%). Four out of eight patients treated with Flowtron s howed 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 ar m swelling. This applies to different modalities and prolonged periods of t reatment are required to check progression. Application of stockings is the simplest way to treat postoperative oedema. In most cases postoperative oe dema appeared during the first year after surgery and the most severe cases occurred after irradiation.