The investigation of postmastectomy oedema of the arm by lymphography and venography

Abstract

Following mastectomy for carcinoma of the breast, the incidence of oedema of the arm may range from 10% after simple mastectomy to 45% after radical mastectomy combined with radiotherapy. The affected arms of six patients with severe postmastectomy oedema of the upper arm and forearm were examined by lymphography and venography. In all cases the main lymph vessels in the arm were obstructed, thin collateral vessels were present and there was extensive dermal backflow. The number of axillary nodes outlined on the 24 h film was four or less compared with the normal figure of 15 or more. There was no evidence of metastatic disease. A lymphocyst was present in two cases. Venography demonstrated obstruction of the axillary and cephalic veins in one case. In the other five cases the axillary veins were normal although there were varying degrees of narrowing and obstruction of the cephalic vein, basilic vein and of the smaller veins of the upper arm. The results of this series, together with the results of previously reported series, indicate that the usual cause of postmastectomy arm swelling is lymphatic obstruction and that venous obstruction contributes only occasionally. A review of the literature suggests that lymphoedema of the arm will complicate mastectomy if an adequate collateral circulation fails to develop after the main vessels draining the arm have been resected and that this is more likely to happen after radical surgery and radiotherapy.