Ay, A.A., Kutun, S., & Cetin, A. (2014). Lymphoedema after mastectomy for breast cancer: importance of supportive care. South African Journal of Surgery (Suid-Afrikaanse Tydskrif Vir Chirurgie), 52, 41–44. 

To evaluate the impact of rehabilitative, medical, and physical therapies or a lack of these interventions on the development of breast cancer-related lymphedema

This was a retrospective study of the medical records and follow-up forms of 5,064 women with breast cancer between 1995 and 2010. Preoperatively, all patients were instructed in risk reduction behaviors (no needles and no blood pressure measurements on the affected side). During the postoperative period, pressure dressings on the axillary fossa and flap region were used during the first five days. Venous cannulation was avoided in the involved arm during the first two postoperative years. Patients attended routine follow-up visits. Patients who received adjuvant radiotherapy also were treated in the axillary area. Cyclophosphamide, adriablastin, 5-fluorouracil, and docetaxel were used for first-line adjuvant chemotherapy. All patients were referred to physiotherapy and the rehabilitation clinic postoperatively. Patients were taught daily self-drainage massage techniques and flexibility and strength exercises. Patients were educated about lymphedema symptoms, skin care, and general protective measures, and they were given written materials.

• N = 5,064
• MEDIAN AGE = 51 years (range = 34–75 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients with stages 2 and 3 breast cancer 
• OTHER KEY SAMPLE CHARACTERISTICS: Modified radical mastectomy with levels 1–3 axillary dissection; Stewart transverse incision; Cooper’s ligaments involved; axillary dissection included dissecting under the pectoralis minor muscle; exclusion criteria included limb trauma, vascular disease, thromboembolic events, neoadjuvant chemotherapy or radiotherapy, uncontrolled diabetes, cardiovascular disease, or history of serious infection or surgery on the affected side

• SITE: Single site    
• SETTING TYPE: Not specified    
• LOCATION: Turkey

• PHASE OF CARE: Multiple phases of care

Retrospective, two-group design (physiotherapy group participated in physiotherapy and did exercises regularly, no physiotherapy group did not receive physiotherapy or did not do exercises regularly)

• Difference in circumference measured pre- and postoperatively > 5%

Overall, 19.9% of patients developed lymphedema. It was significantly less common in patients who participated in physiotherapy than in those who did not (p <  0.001), and it was more common in patients with a body mass index (BMI, kg/m²) between 30–34.9 than in those with lower BMIs (p < 0.001).

Educating patients about the risk factors (e.g., weight management) of lymphedema and referring them to postoperative physical therapy and rehabilitation clinics may be an important way to prevent postoperative lymphedema.

• Risk of bias (no random assignment)
• Other limitations/explanation: Retrospective design; single-site study

Educating patients about the risk factors for developing lymphedema pre- and post-treatment is important. All patients who received aggressive surgeries and do not have lymphedema will benefit from referral to a physical therapy program to teach exercises. Nurses can teach risk reduction guidelines.