The Treatment of Postmastectomy Lymphedema

Swelling of the arm following radical mastectomy may become severe, painful, and quite disabling. The problem has been with us since the beginining of radical breast surgery. It was thoroughly studied by Halsted,¹ and his observations and opinions on the subject remain a classic to this day. He observed that in many instances, a year or more following the operation and without return of the disease, there would occur sudden or gradual swelling of the upper extremity. Halsted also studied patients with swelling of the arm in whom no surgery had been done, as well as those in whom late postoperative swelling accompanied a recurrence of the disease. In many instances when Halsted removed the axillary and supraclavicular nodes and resected a portion of the subclavian and axillary veins, no edema of the arm developed. He further observed that less difficulty occurred after skin grafting than after some plastic closures.