INTRODUCTION
MLD, breast cancer, lymphoedema, lymphedema, Lymphoedema, oedema
BREAST CANCER, LYMPHOEDEMA, ARM SWELLING, MLD, OEDEMA, LYMPHEDEMA, LYMPHOEDEMA, COMPLICATIONS
As survival for breast cancer has improved with better treatments, management of the long‐ term complications that reduce patient's quality of life (QoL) is increasingly important for patient care.Increases in the relative ipsilateral arm volume (versus the contralateral arm) of more than 10% is accepted criteria for the diagnosis of lymphoedema.Both a meta‐analysis and a large prospective UK study found high Body Mass Index (BMI) predicted development of lymphedema after axillary node clearance (dissection) surgery.It is unknown whether BMI interferes with the ability of garment sleeves to provide sufficient compression to the arm.A small US army cohort study of 43 women (in a group of patients with early 3–9% RAVI arm swelling) treated with arm sleeves for a median 4.4 months claimed early intervention of the compression arm sleeves prevented the development of chronic lymphoedema.Both in the United States in the National Lymphoedema Network GuidelinesCompression garments, which reduce the amount of interstitial fluid, are graduated with the greatest compression at the distal end and the least compression at the proximal end thus covering the entire area of oedema.Early arm swelling predicts development of lymphoedema.A trial of Manual Lymphatic Drainage (MLD) compared to arm exercises in women with early arm swelling after axillary surgery found that 28% control and 24% MLD patients developed LE (defined as Relative Arm Volume Increase (RAVI) > 10%) and concluded manual lymphatic drainage did not prevent LE development.Currently there is no large randomised trial evidence to support the value of compression garments in preventing lymphoedema after ANC. We tested the hypothesis whether early intervention in a group of patients with increased lymphoedema risk (RAVI 4–9% arm swelling) using a compression garment and supportive treatment compared to supportive treatment alone (written advice, arm elevation exercises and massage) reduces the subsequent development of lymphoedema and improves QoL in patients presenting through a surveillance programme following surgery who had developed a RAVI of 4–9%.