Research Update: Mastectomy and Upper Body Extremities

Mastectomy is a common treatment for women with breast cancer. Some patients that need a mastectomy also have to have other lymph node tissue removed from the axillary (armpit) region on the same side that the breast tissue was removed from. These patients are frequently advised to avoid treatments, procedures or surgeries on the arm or hand that is located on the side they had the breast and axillary tissue removed from. These treatments include blood pressure monitoring, tourniquet use, having blood drawn, or any other type of invasive or non-invasive maneuvers.

Surgeons treating these patients have differing opinions regarding how to operate in this patient population. Many surgeons will not operate on these patients at all because of the belief that the operation could cause a significant swelling (edema) of that arm or hand. Other surgeons may choose to operate, but they may use additional precautions such as not using a tourniquet (or using a tourniquet for less time), or using antibiotics to prevent any type of complication. Postoperative care also varies as some surgeons prefer to have their surgical patients elevate their arm or hand as a precaution against extreme swelling, while other surgeons prefer that their patients use compressive garments to keep swelling to a minimum.

There is not good scientific evidence for or against the precautions that are taken by some surgeons to avoid the swelling that may occur after a procedure. Because of that, many patients may steer away from medically necessary elective hand surgery, believing that they may have to deal with the swelling following surgery. The criteria for participation limits itself to a small population of women who need hand and/or wrist surgery and who have a past history of breast cancer. Regardless of the challenges, we hope to answer this important question.

In 2010, Dr. Glenn Gaston of the OrthoCarolina Hand Center, through his research with the OrthoCarolina Research Institute (OCRI), was awarded a grant from The American Society for Surgery of the Hand (ASSH) to further investigate this issue. Patients were enrolled in this study by Dr. Gaston and OCRI under the title, “Lymphedema following elective hand surgery: A prospective, randomized, trial".