Breast Cancer Surgery Disclaimer

Lymphadenopathy

The surgical treatment for breast cancer has evolved from radical mastectomy with extensive axillary lymph node dissection, chest muscle resection and irradiation to modified mastectomy, selective lymph node biopsy and focused irradiation. With the original more extensive surgical management lymphedema was a real and not infrequent complication.

Women were therefore advised to avoid blood pressures, needle sticks and elective upper extremity surgery for fear of increased risk of infection and lymphedema. Review of the literature reveals only anecdotal cases of such complications and no prospective studies that demonstrate elective upper extremity surgery causing any of these complications.

Several case series of upper extremity surgery in women with prior ipsilateral surgery or radiation for breast cancer have shown no new development of lymphedema nor increased risk of infection even in women with pre-existing lymphedema. A recent Hand Society survey of its members inquiring about their experience with elective surgery in breast cancer patients concluded surgery was safe even with the use of a tourniquet.

References:

  • Mann T, Hammert WC. Upper extremity surgery after lymph node dissection. J Hand Surg 2011;36A(10):1684-1686.
  • Gharbaoui IS, Netscher DT, Thornby J, Kessler FB. Safety of upper extremity surgery after prior treatment for ipsilateral breast cancer: results of an American Society for Surgery of the Hand membership survey and literature review. J Hand Surg 2005;5:232-38.
  • Habbu R, Adams JE. Role of elective hand surgery and tourniquet use in patients with prior breast cancer treatment. J Hand Surg 2011;36A(9):1537-1540.
  • American Medical Association
  • American Society for Surgery of the Hand - ASSH
  • American Academy of Orthopaedic Surgeons - AAOS
  • American Board of Orthopaedic Surgery
  • North American Spine Society - NASS
  • American Association of Hip & Knee Surgeons - AAHKS