Indian Journal of Surgery

, Volume 81, Issue 1, pp 16–22 | Cite as

Post Mastectomy Lymphedema—a Prospective Study of Incidence and Risk Factors

  • Soumya Khanna
  • Ashish Kumar GuptaEmail author
  • Anish Jacob Cherian
  • Bijesh Yadav
  • Paul Mazhuvanchary Jacob
Original Article


The aim of this study is to document the incidence of early lymphedema and study the risk factors influencing post mastectomy lymphedema. It is a prospective cohort study involving 98 adult women who underwent surgery including axillary lymph node dissection for biopsy-proven breast carcinoma. Serial measurements of the arm were taken preoperatively and postoperatively at 3, 6 and 12 months. Lymphedema was diagnosed if there was an increase in girth by more than 2 cm in the concerned limb. All patients received standard lymphedema prevention advice. Risk factors assessed were age, body mass index, comorbid conditions, hypertension, medications, socioeconomic status, upper limb symptoms, laterality of disease, type of surgery, stage of the disease, histopathology, node status, wound complication, receptor status, seroma volume, duration of seroma drainage, radiotherapy, chemotherapy, post radiation skin reaction and post therapy weight gain. The statistical analysis was done using chi-square test with SPSS version 16. The incidence of lymphedema was 23.47%. The univariate analysis showed that prolonged or high volume seroma, taxane-based chemotherapy, radiotherapy to axilla and skin necrosis following radiation were significantly associated with lymphedema. In the multivariate analysis, only post radiation skin necrosis was significant.


Post mastectomy lymphedema Breast cancer-related lymphedema Upper limb oedema Arm lymphedema Lymphedema 



The authors would like to acknowledge Dr. Jayaprakash Muliyil, Professor, Department of Community Medicine, Christian Medical College, Vellore, for his help in analysing the data.

Compliance with Ethical Standards

This prospective observational cohort study was carried out at the Department of Plastic Surgery and Endocrine Surgery, Christian Medical College (CMC) Hospital, Vellore, from 2011 to 2013. The study was approved by the Institutional Review Board and ethics committee.

Conflict of Interests

The authors declare that they have no conflict of interest.


  1. 1.
    Quirion E (2010) Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: a guide for primary care providers. J Am Acad Nurse Pract 22(9):450–459. CrossRefGoogle Scholar
  2. 2.
    Norman SA, Localio AR, Kallan MJ, Weber AL, Simoes Torpey HA, Potashnik SL, Miller LT, Fox KR, DeMichele A, Solin LJ (2010) Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomark Prev 19(11):2734–2746. CrossRefGoogle Scholar
  3. 3.
    Cormier et al (2010) Lymphedema beyond breast cancer. Cancer 116(22):5138–5149. CrossRefGoogle Scholar
  4. 4.
    Armer JM (2010) Research on risk assessment on secondary lymphedema following breast cancer treatment. Cancer Epidemiol Biomark Prev 19(11):2715–2717. CrossRefGoogle Scholar
  5. 5.
    Tadych K, Donegan WL (1987) Postmastectomy seromas and wound drainage. Surg Gynecol Obstc 165:483–487Google Scholar
  6. 6.
    Bertelli G, Venturini M, Forno G, Machaivello F, Dini D (1992) An analysis of prognostic factors in response to conservative treatment of postmastectomy lymphedema. Surg Gynecol Obstc 175:455–460Google Scholar
  7. 7.
    Devoogdt N, Chtistiaens M-R, Geraerts I et al (2011) Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphedema related to breast cancer: randomised controlled trial. BMJ 343(sep01 1):d5326. CrossRefGoogle Scholar
  8. 8.
    Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G (2001) Prognostic factors of lymphedema after primary treatment of breast carcinoma. Cancer 92(7):1783–1787.<1783::AID-CNCR1694>3.0.CO;2-G CrossRefGoogle Scholar
  9. 9.
    Hinrichs CS, Watroba NL, Rezaishiraz H et al (2004) Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol 11(6):573–580.
  10. 10.
    Deo SVS, Ray S, Rath GK, Shukla NK, Kar M, Asthana S, Raina V (2004) Prevalence and risk factors for development of lymphedema following breast cancer treatment. Ind J Cancer 41(1):8–12Google Scholar
  11. 11.
    Pillai PR, Sharma S, Ahmed SZ, Vijaykumar DK (2010) Study of incidence of lymphedema in Indian patients undergoing axillary dissection for breast cancer. Indian J Surg Oncol 1(3):263–269. CrossRefGoogle Scholar
  12. 12.
    Guedes Neto HI (1997) Arm edema after treatment for breast cancer. Lymphology 30(1):35–36Google Scholar
  13. 13.
    Erickson VS, Pearson ML, Ganz PA, Adams J, Khan KL (2001) Arm edema in breast cancer patients. J Natl Cancer Inst 93(2):96–111. CrossRefGoogle Scholar
  14. 14.
    Petrek JA, Heelan MC (1998) Incidence of breast carcinoma-related lymphedema. Cancer 83(12 Suppl American):2776–2781Google Scholar
  15. 15.
    Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, Miller LT, DeMichele A, Solin LJ (2009) Lymphedema in breast cancer survivors: incidence, degree, time course, treatment and symptoms. J Clin Oncol 27(3):390–397. CrossRefGoogle Scholar
  16. 16.
    Fu MR, Guth AA, Cleland CM, Lima ED, Kayal M, Haber J, Gallup L, Axelrod D (2011) The effects of symptomatic seroma on lymphedema symptoms following breast cancer treatment. Lymphology 44(3):134–143Google Scholar
  17. 17.
    Thomson DR, Sadideen H, Furniss D (2013) Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev (10):CD006823.
  18. 18.
    Jung SY, Shin KH, Kim M, Chung SH, Lee S, Kang HS, Lee ES, Kwon Y, Lee KS, Park IH, Ro J (2014) Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Res Treat 148(1):91–98. CrossRefGoogle Scholar
  19. 19.
    Lee MJ, Beith J, Ward L, Kilbreath S (2014) Lymphedema following taxane-based chemotherapy in women with early breast cancer. Lymphat Res Biol 12(4):282–288. CrossRefGoogle Scholar
  20. 20.
    Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH (2010) Risk factors for lymphedema in a prospective breast cancer survivorship study: the pathways study. Arch Surg 145(11):1055–1063. CrossRefGoogle Scholar
  21. 21.
    Liao SF, Lee YL et al (2009) Incidence and risk factors analysis of lymphedema secondary to breast cancer. Tw J Phys Med Rehabil 37(4):217–225Google Scholar
  22. 22.
    Moran MS, Haffty BG (2009) Radiation techniques and toxicities for locally advanced breast cancer. Semin Radiat Oncol 19(4):244–255.
  23. 23.
    Helyer LK, Varnic M, Le LW, Leong W, McCready D (2010) Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J 16(1):48–54. CrossRefGoogle Scholar
  24. 24.
    Armer J, Fu MR (2005) Age differences in post-breast cancer lymphedema signs and symptoms. Cancer Nurs 28(3):200–207CrossRefGoogle Scholar
  25. 25.
    Parbhoo S (2006) Lymphedema in young patients with breast cancer. Breast 15(Suppl 2):S61–S64. CrossRefGoogle Scholar
  26. 26.
    Rockson SG (1998) Precipitating factors in lymphedema: myths and realities. Cancer 83(S12B):2814–2816.<2814::AID-CNCR31>3.0.CO;2-E CrossRefGoogle Scholar
  27. 27.
    Mak SS, Yeo W, Lee YM, Mo KF, Tse KY, Tse SM, Ho FP, Kwan WH (2008) Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res 57(6):416–425. CrossRefGoogle Scholar
  28. 28.
    Rovere GQ, Ahmed I, Singh P, Ashley S, Daniels IR, Mortimer P (2003) Audit of the incidence of arm lymphedema after prophylactic level I/II axillary dissection without division of pectoralis minor muscle. Ann R Coll Surg Engl 85(3):158–161. CrossRefGoogle Scholar
  29. 29.
    Coriddi M, Khansa I, Stephens J, Miller M, Boehmler J, Tiwari P (2015) Analysis of factors contributing to severity of breast cancer-related lymphedema. Ann Plast Surg 74(1):22–25.
  30. 30.
    Hayes SC, Janda M, Cornish B, Battistutta D, Newman B (2008) Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clinic Oncol 26(21):3536–3542. CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Soumya Khanna
    • 1
  • Ashish Kumar Gupta
    • 1
    Email author
  • Anish Jacob Cherian
    • 2
  • Bijesh Yadav
    • 2
  • Paul Mazhuvanchary Jacob
    • 2
  1. 1.Max Super Specialty Hospital, SaketNew DelhiIndia
  2. 2.Christian Medical College and HospitalVelloreIndia

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