Zimmermann, A., Wozniewski, M., Szklarska, A., Lipowicz, A., & Szuba, A. (2012). Efficacy of manual lymphatic drainage in preventing secondary lymphedema after breast cancer surgery. Lymphology, 45(3), 103–112.

To evaluate effectiveness of manual lymphatic drainage (MLD) for prevention of secondary lymphedema after breast cancer surgery

From the second post-operative day, women received a standard program of exercises. Thirty-three women were randomly chosen to also receive MLD five times a week for the first two weeks, then twice a week until six months after surgery. The other control group women applied self-drainage. Data were collected prior to surgery and at six months postoperatively. Arm volume measurements were done on days 2, 7, 14, and 3 and 6 months.

• The study sample (N = 67) was comprised of female patients with breast cancer.
• Mean age was 59.4 years.
• In the sample, 80% had breast conserving surgery and 40% had modified radical mastectomy; 52% had axillary lymph node dissection.
• In the control group, 74% had radiotherapy, compared to 67% in the MLD group. 
• More women in the control group also received other adjuvant therapy, compared to the MLD group.

The study took place at a single outpatient site in Poland.

The patients were undergoing multiple phases of care.

The study used a prospective trial design.

Water displacement was used to measure arm volume.

Women in the MLD group showed a reduction of 14 ml volume (SD = 470 ml) on the operated-side arm over six months. Women in the control group showed an overall increase in arm volume of 16 ml (SD = 470, p = 0.0033). Analysis of variance showed significant effect of having MLD (p = 0001) and radiotherapy (p = 0.0499) on arm volume.

Findings showed that use of MLD may have some benefit for prevention of lymphedema secondary to breast cancer surgery. Several study limitations suggest that findings should be used with caution.

• The sample size was small, with less than 100 participants.
• The baseline sample and group differences could influence results.
• The study had a risk of bias because of no binding and no random assignment.
• The ample included various surgical types. 
• It is not clear that patients were randomly assigned to groups. 
• Adherence to MLD and self-management are not discussed, and no other interventions that may affect lymphedema are discussed. 
• The control group had a higher percent of women receiving radiotherapy, which was shown to predict arm volume increase.
• There was high variability in arm volume results in both groups compared to mean changes observed.

Findings of the study do not provide strong support for effectiveness of MLD to prevention lymphedema after breast surgery because of the multiple study design and results limitations.