Delayed swelling of the upper extremity: impaired lymphatic return after breast cancer surgery

  Breast cancer has now become one of the most common malignancies in middle-aged women, and axillary debridement is one of the necessary steps, whether it is a modified radical, radical or extended radical procedure. In axillary debridement, skeletonization of the axillary artery, or at least the inferior border of the axillary artery, is necessary, which greatly affects the lymphatic return to the affected limb. “The supraclavicular lymph node is the bottleneck of lymphatic return to the affected limb. In breast cancer lymphatic metastasis, once the supraclavicular lymph node has metastasized, it often means that the lymphatic return to the affected limb is restricted. Post-operative radiotherapy for breast cancer is destructive to the lymph around the axillary vein. These factors make breast cancer perioperative prone to lymphatic return disorder in the affected limb The occurrence of lymphatic return disorder in breast cancer is insidious, and the sudden swelling is often due to deep vein thrombosis in the affected limb, accidental ligation of axillary vein or other factors of venous return disorder. The symptoms are insidious, starting from the proximal end and gradually spreading to the whole upper limb, with a “white swelling”, mostly non-depressed, and the symptoms may be aggravated by prolonged drooping. The fingers are the last to be affected after progressive development of the entire upper extremity, when the folds, such as the transverse wrist line, are depressed. When the disease progresses to advanced stage, verrucous hyperplasia, orange peel sign, cellulitis, peeling, fatigue and psychological depression will appear.  For postoperative lymphatic reflux disorder in breast cancer, the treatment lies in: standardized breast cancer surgery, emphasis on prevention, prevention of secondary infection, appropriate pressure therapy, and for those who progress rapidly and have a patent lymphatic trunk, diversion surgery can be performed on the basis of pressure therapy.