Postmastectomy syndrome.

This is a complex of symptoms, which emerges in a part of patients after radical treatment of breast cancer (currently breast cancer is in the first place among all female cancers).

Lymphedema of the right upper limb.

Shoulder circumference decreased by 10 cm. Term of treatment five days.

Postmastectomy syndrome (PMS) includes:

• lymphatic edema (lymphostasis, lymphedema) of the upper limb, anterior chest wall, shoulder girdle (develops in 35-40% of patients);
• impaired venous flow from the affected limb;
• scarring of chest wall (absence of breast)
• scarring of the axillary area (due to excision of axillary lymph nodes);
• motion dysfunction in the shoulder joint – 40% of patients suffer from insignificant limitation of volume of movement in the shoulder joint up to contracture of the shoulder joint;
• affected shoulder nervous plexus with development of sensory and motor disorders, impaired regulation of vascular tone, peripheral neuropathy;
• radiation burn of tissues (following radiation treatment);
• fibrosis of the upper limb tissues, shoulder girdle, anterior chest wall and scapular area;
• addition of erysipelas;
• psychoemotional disorders related to underlying cancer and sequela of the experienced surgical procedure;
• later on disorders of blood flow through cervical vessels up to impaired cerebral circulation may develop.

Lymphoangiosaroma may develop with longstanding underlying lymphedema.

PMS are distinguished by time of development. Early –at the stage of surgical treatment. Late – develops within several months up to several years.

Outcome of treatment of postmastectomy syndrome, operated 11 years ago. Decrease of circumference by 8 cm in 15 sessions.

Classification of postmastectomy edema (lymphostasis of the upper limb, lymphedema of the upper limb):

Stage 1 –limb circumference increased up to 150 ml (compared with the healthy limb).

Stage 2 – from 150 –to 300 ml, or + 1-2 cm of the shoulder circumference.

Stage 3 – from 350 – up to 500 ml, or + 2-4 cm of shoulder circumference.

Stage 4 – from 500 –up to 700 ml, or + 4-6 cm of shoulder circumference.

Stage 5 – above 700 ml and shoulder circumference above 7 cm.

Treatment of postmastectomy syndrome

Treatment of PMS may be subdivided into conservative and surgical.

Depending on specific lesion of this or that system patient-centered treatment shall be prescribed. Treatment regimen shall be prescribed by the doctor specializing in this field. Only this can lead to good outcome.

The picture below shows result of treatment of one of the patients of our clinic.

Operated 8 years ago. Lymphostasis (lymphedema) for three years. Circumference decreased by 2 cm after five treatment sessions.