What causes lymphedema following axillary lymph node dissection (ALND) in the surgical treatment of breast cancer and how is it managed?

Updated: Feb 13, 2019
  • Author: Mary Jo Wright, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

Lymphedema is the abnormal accumulation of protein-rich edema fluid in the upper extremity following axillary lymph node dissection. This occurs because a portion of the lymphatics that drain from the breast to the axilla and those that drain from the arm are shared within the axilla. [27]

Early detection of lymphedema is paramount, as lymphedema is potentially reversible when treated in its earliest stage. Compression garments and physical therapy with lymphatic massage remain the backbone for the treatment of lymphedema.

Patients who have an axillary lymph node dissection should be cautioned about the risk of lymphedema and should take precautions to avoid breaks in the skin or infections in the affected extremity. Lymphedema may develop at any time after lymph node dissection but most commonly occurs within the first 2 years after the surgery.

Risk factors for developing lymphedema include obesity and radiation therapy. Although patients are commonly advised to avoid having blood pressure measurements taken or intravenous catheters placed in the affected arm after axillary lymph node dissection, no level I or level II evidence supports these recommendations.


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