Haghighat, S., Lotfi-Tokaldany, M., Yunesian, M., Akbari, M. E., Nazemi, F., & Weiss, J. (2010). Comparing two treatment methods for post mastectomy lymphedema: Complex decongestive therapy alone and in combination with intermittent pneumatic compression. Lymphology, 43(1), 25–33.

To compare two treatment methods for postmastectomy lymphedema: complex decongestive therapy (CDT) and modified CDT (MCDT) combined with intermittent pneumatic compression (IPC)

Patients were randomly assigned to a treatment arm. The CDT group alone served as the control group while the experimental group received MDCT combined with IPC. Edema volume (difference between affected and unaffected arms) was recorded initially, at the final session of phase I, and at the end of the three months follow-up. Treatment was administered five days a week for 10–15 sessions. The experimental group included skin care, 45 minutes of manual lymph drainage (MLD), remedial exercises, and compression applied by multilayered, short-stretch bandages. Lymph drainage was stimulated in the trunk with 10–15 minutes of MLD on the abdomen; chest; and axillary, inguinal, and cervical lymph nodes followed by a four-chamber pneumatic sleeve and intermittent pneumatic compression pump at 40 mm Hg pressure for 30 minutes.

• The study sample (N= 112) was comprised of female patients with postmastectomy lymphedema (defined as 10% or greater increase in the volume of affected arm compared to that of the contralateral arm).
• Mean age was 53.4 years in the control group and 52.7 years in the experimental group.
• Of 112 patients, two in the control group and one in the experimental group were excluded because of low follow-up compliance.

The study took place in the Outpatient Lymphedema Clinic of the Iranian Center for Breast Cancer.

The study has clinical applicability for patients with breast cancer associated with lymphedema.

The study used a randomized controlled trial design.

Volume of edema was measured by water displacement method and performed by a blinded investigator not engaged in treatment.

CDT alone or in combination reduced edema volume. CDT alone provided better results in both treatment phases. Limb volume measured at three months post-treatment showed 16.9% volume reduction by CDT alone and 7.5% reduction by MCDT plus IPC.

Further studies are needed to evaluate a multimodal approach to lymphedema. These findings do not support a significant improvement with IPC.

Qualified lymphedema specialists are needed to care for this group of patients and to work with medical device companies to evaluate equipment and techniques. Patient education and support is needed for compliance.