I have mentioned lymph drainage before. It is a gentle massage technique applied along the lymph vessels and nodes to stimulate lymph flow. All sorts of extraordinary claims are made for this treatment. In particular, lymphoedema after surgery for breast cancer, which can be a debilitating complication, is claimed to be preventable with this approach. This seems vaguely plausible, but does it really work?
This study tested whether manual lymphatic drainage (MLD) or active exercise (AE) are associated with improvements in shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery, and whether these parameters have an association with lymphoedema formation in the long run.
The researchers conducted a clinical trial with 106 women undergoing radical BC surgery. Women were matched for staging, age and body mass index and were allocated to AE or MLD, twice weekly during one month after surgery. The wound was evaluated two months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery.
The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphoedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphoedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011).
The authors concluded that lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.
I am not sure I agree with these conclusions; to me, they seem a bit over-optimistic. The results fail to show that MLD is clinically effective, as both AE and MLD might be equally ineffective. In fact, in the discussion section of the paper the authors state that their study suggests that AE may be more effective than MLD for the prevention of lymphedema in women older than 39 years.
So far, only very few controlled clinical trials tested the MLD effects in the prevention of lymphedema after breast cancer. Some suggested that MLD administered early in the postoperative period can effectively prevent lymphedema, whereas others failed to find positive effects of MLD. Thus the question whether MLD is effective for lymphoedema after breast cancer remains open.
For once, the call for more and better research seems justified.