Dr. Vella on Hand Surgery and Breast Cancer Patients

One of the more troublesome issues surrounding breast cancer surgery and lymph node dissection is the development of lymphedema in the arm. Traditionally these patients have been warned against having blood pressures taken, IV’s placed and surgery performed on the same side as lymph node dissection. However, recent research suggests that surgery is safe in patients who have previously had mastectomy and lymph node dissection.

A 2007 article studied 25 women who previously had mastectomy and lymph node dissection. Four of these women had a history of lymphedema. All of these patients underwent hand surgery on the same side as their lymph node dissection. There was no increased risk of infection in this group. Only 2 had a temporary worsening of their lymphedema. Of the women who never experienced lymphedema in the past, none of them developed it after hand surgery.

Another study in 1995 studied 15 women who had lymph node dissection and hand surgery. Seven of these women had a history of lymphedema. All of these women had hand surgery and none of them developed any symptoms of lymphedema after surgery.

While there is a perception, mainly among breast care nurses and breast surgeons, that hand surgery should not be performed after lymph node dissection, literature supports that it is safe. These articles suggest that hand surgery after lymph node dissection does not increase risk of developing lymphedema after surgery. Hand surgery is safe for women who have had mastectomy and lymph node dissection.

My hands helping your hands.
Josh C. Vella, M.D.

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Breast J. Hershko: Safety of Elective Hand Surgery following axillary Lymph node Dissection. 2007;13(3):287-90

Ann Surg Onc. Dawson: Elective Hand Surgery in Breast Cancer patient with prior ipsilateral axillary dissection. 1995; Mar;2(2): 132-7

Ann R Coll Surg Eng: Fulford: Hand Surgery after Axillary Lymph Node clearance. 2010; Oct:92(7):573-