Has Manual Lymphatic Drainage (MLD), immediately applied after the axillary dissection during 5 months, a preventive effect on the development of arm lymphedema

Aim: To examine if MLD, applied postoperatively on breast cancer patients, has an influence on the development of lymphedema.
Patients: All patients with an invasive breast cancer are measured preoperatively. The patients with a unilateral axillary dissection are asked to participate in the study. Power analyse has showed that at least 146 patients have to participate.
Method: The patients are randomly allocated to the experimental group, receiving MLD and exercises, or the control group, receiving only exercises. Both groups are treated during 5 months either in our hospital or by a physiotherapist in the periphery. They undergo preoperatively and 1, 3, 6 and 12 months after the breast surgery the following measurements: arm volume and shoulder mobility. The patients fill in the 'LYMF-SBP' questionnaire, to score the functioning problems of the patient. Forty patient volunteers, equally divided between both groups, undergo also a lymphoscintigraphy before the start of the therapy, immediatly after and 6 months after the therapy.

1. Patients, receiving MLD and exercises after breast cancer surgery with axillary dissection are less at risk to develop an arm lymphedema, compared with patients receiving only exercises;

2. Patients, receiving MLD and exercises after breast cancer surgery with axillary dissection have less functioning problems, compared with patients receiving only exercises;

3. Patients, receiving MLD and exercises after breast cancer surgery with axillary dissection have more visible axilloaxillary anastomoses after 5 months of therapy and have more visble rerouting of lymphatics from the arm to the trunk, compared with patients receiving only exercises;

4. Patients, receiving standardised MLD performed by a specialist in lymphedema therapy (in our hospital), develop less frequently arm lymphedema, compared with patients receiving MLD performed by a physiotherapist in the periphery.

1. In the periphery: not standardised;

2. In our hospital: standardised;

Control group: Exercises.

Experimental group: Exercises + MLD.

Exercises: The patient performs an exercise schema independently at home. The physiotherapist performs mobilisations of the shoulder and verifies of the patient does her exercises well and follows the exercise schema. Duration of 1 session is 30 min, frequency is 1 / week, total amount of sessions is 20.

MLD: MLD method Leduc and method Vodder is applied in a standardised matter. Duration of 1 session is 30 min, frequency is variable between 1 / week and 3 / week, total amount of sessions is 40.