Lymphedema After Radical Mastectomy:

Asem Fathy Afify

SUMMARY AND CONCLUSIONLymphedema is a common and senous complication alkl”radical mastectomy. It’s believed that it is the most distressing andunpleasent for the patient and particulary frustrating for the surgeons.The incidence varies from study to other. However, somesurgeons reported a high incidence which may reach 62.5%, and itwas found that the incidence was increased with longer period offollow-up. The aeliology of postmastectomy lymphedema is acomplex, and is not fully understood. It may be due to excessiveextirpation or destruction of lymph nodes and lymphatic collectors inthe axilla; and inability of this lymphatic collectors to regenerate,leading to reduction in lymph transport capacity, and hence thedevelopment of lymphedema.It was found that recurrent attaks of infections playa majorrole in the production and exageration of lymphedema. Also, theincidence, of lymphedema is increased, which may reach 47.5% ifradical mastectomy is accompanied with radiotherapy either pre- orpostoperatively. Other factors such as, obesity, age of the patients,and hypertension may playa role in pathogenesis of postmastectomylymphedema. Recently, it was found that, the underlying lymphaticabnormalities and inadequate lymphatic collaterals, which may bepresent before radical mastectomy, is the predisposing factor for thedevelopment of lymphedema postoperatively.The complications of lymphedema after radical mastectomyvaries from recurrent attacks of cellulitis to lymphangiosarcoma,_____________ Sumlllary and COltclIlS;OIl - 73-which is a rare but lethal complication. Diagnosis 01”lymphedema ISsupported by clinical finding of swollen extremity, volumedisplacements and circumferential measurements. TIll’ level ofobstruction can be identified by lymphangiography or by radioisotopicscaning. Once lymphedema is established it is nevereradicated, so, the best method of its treatment is to prevent itsoccurrence, several factors which may be helfpful in prevention oflymphedema, this factors may be related to patients, surgery, orradiotherapy.The patients are adviced to avoid minimal injuries of theaffected limbs. The factors related to surgery and woud care includeavoidance of wound infections, and post-operative seroma formation.Radiotherapy should not be accompanied with complete surgicaldissection of the axilla. It is believed that the treatment oflymphedema is mainly conservative. The conservative treatment canbe divided into two main categories; pharmachological, andmechanical or physical.The surgical management of postmastectomy lymphedema islimited, and can be divided into two main categories; the excisionaland the drainage operations.Finally.. five main important points should be kept in mind:o Lymphedema after radical mastectomy is a permanent, noncurable problem, once it is established it is never eradicated.e The combination of radical mastectomy and radiotherapy increasethe incidence.@) The infections playa major role in the etiology.______________ Sumnrary and Conclusion - 74-e The treatment of this problem is mainly conservative,o No surgical operation can cure lymphedema, and recurrence is therole after all surgical procedures.Recommendations:We recommend further study on lymphedema aftermastectomy and its relation to varies etiological factors, and try toreach a satisfactory protocol in its treatment. Also, we recommendfurther co-operation between surgeons, radiologists, and physiotherapeutists in facing this major problem.