Prevention and conservative treatment of upper limb secondary lymphedema after mastectomy

Abstract

Introduction: Lymphedema is a frequent complication in women after mastectomy. It affects the patient's quality of life and functionality. The aim of this systematic review was to investigate and report appropriate, and evidence-based, guidelines for the prevention and treatment of secondary lymphedema of the upper extremity after mastectomy. Methodology: Relevant Greek and international literature was searched in the electronic databases PubMed, Cinahl, Sciverse, Scopus and Proquest by using keywords and time restriction. Results: Thirty-six papers were retrieved, of which 29 fitted the study’s inclusion criteria. These papers were addressing five categories of post-surgery interventions: Manual Lymphatic Drainage (MLD), Pneumatic Compression Devices (PCDs), physiotherapy exercises, weight lifting and the use of low frequency laser. MLD is a conventional method with controversial therapeutic effects. Similar are the effects of PCDs, which are predominantly used by patients even at home setting. Physiotherapy exercises are indicated to prevent lymphedema immediately after surgery, while weight lifting does not seem to have a negative effect despite current beliefs. Alternative treatments such as hydrotherapy, yoga, and low laser treatment are under investigation. Standard therapeutic approach includes Complete Decongestive Therapy (CDT), i.e. the combination of Manual Lymph Drainage (MLD), Pneumatic Compression Devices (PCDs), skin care, compression bandages and physiotherapy exercises. Conclusion: Complete Decongestive Therapy (CDT) is the basis of therapeutic interventions with the remaining methods having a complementary role. However, the effectiveness of interventions is not well documented and more research is needed.