Secondary lymphedema of the arm following primary therapy of breast carcinoma.

1107 cases of lymphedema of the ipsilateral arm (27%) were found in 4011 female breast cancer patients suffered from 4101 breast cancer, seen in the Bad Trissl hospital between 1972 and 1990. The right arm was affected in 47.5%, the left in 52.5%. Primary treatment had consisted of operation alone in 1630 patients with a consecutive rate of edema of 20.3%. Additional irradiation increased this rate up to 31.4% (n = 2471). The rate of edema after radical mastectomy (n = 731), modified radical mastectomy (n = 3149) and breast preserving operation (n = 221) were 39.2% and 9.5% respectively. Adjuvant radiotherapy increased the edema rate of each the surgical procedures (radical mastectomy alone 22.7%, with irradiation 44.7%, modified radical mastectomy alone 19.9%, with irradiation 29.3%, breast preserving operation alone 6.9%, with irradiation 10.4%). During the observation time from 1972 to 1990, the edema rate was reduced from 38% to 18%, reflecting the change of the chosen therapy modalities (radical surgery and conventional irradiation from the 50th's to the early 70th's, breast preserving techniques with modern megavoltage irradiation in the late 80th's). A further reduction of the lymphedema rates by minimization of the aggressiveness of the treatment seems to be possible and should be taken into account for preserving an optimal quality of life.