Abstract
Background
Upper extremity lymphedema, a major complication post-breast cancer surgery, severely impacts quality of life. While body mass index (BMI) is suggested as a risk factor for postoperative breast cancer-related lymphedema (BCRL), evidence is inconsistent. This meta-analysis systematically evaluates BMI’s impact on postoperative lymphedema to resolve discrepancies and provide accurate insights.
Methods
The authors conducted comprehensive literature searches from inception to October 7, 2024, in major English-language databases, including PubMed, Embase, and Cochrane. To assess the association between BMI and postoperative BCRL, odds ratio (OR) with 95% confidence intervals (95% CI) were calculated. Subgroup analyses were also performed to evaluate the impact of BMI on postoperative lymphedema in breast cancer patients across different geographic regions.
Results
This meta-analysis included 16 studies involving 6,057 postoperative breast cancer patients, with sample sizes ranging from 101 to 1,130. The results revealed a significant association between elevated BMI and postoperative BCRL, with an OR of 2.05 (95% CI, 1.53–2.75; P < 0.005) for patients with BMI ≥ 25 kg/m² compared to those with BMI < 25 kg/m². These findings underscore a significant positive correlation between higher BMI and an increased risk of postoperative lymphedema in breast cancer patients.
Conclusions
Our findings demonstrate that a BMI ≥ 25 kg/m² is a significant risk factor for postoperative lymphedema in breast cancer patients. A comprehensive understanding of BMI’s role in lymphedema development post-surgery can inform clinicians and therapists in designing personalized strategies to mitigate this complication.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12672-025-03589-7.
Keywords: Breast cancer, Postoperative complications, Lymphedema, Body mass index, Meta-analysis
Introduction
Breast cancer is projected to be the most commonly diagnosed malignancy among females in 2025, with its mortality rate second only to lung cancer among female malignant tumors [1]. Surgery remains a primary treatment modality for breast cancer, significantly improving patient survival rates [2]. However, despite its therapeutic benefits, the potential complications associated with surgical intervention present critical clinical challenges that require urgent attention.
Breast cancer-related lymphedema (BCRL) is one of the most severe complications following breast cancer surgery, predominantly affecting the upper extremities and axillary region [3]. It is estimated that 20–50% of breast cancer patients develop BCRL postoperatively [3–5]with the highest incidence occurring within 5 years after surgery [3]. Key risk factors for BCRL include age, extent of lymph node removal, type of surgery (mastectomy or axillary lymph node dissection [ALND]), chemotherapy, radiotherapy, disease stage, infection, and postoperative trauma [6]. While high BMI may necessitate larger radiation fields for adequate axillary coverage (Naoum et al., 2023), surgical extent (e.g., ALND vs. SLNB) remains the primary determinant of lymphedema risk. Thus, BMI-stratified surgical decision-making is critical [7]. The pathogenesis of BCRL involves surgical damage to the lymphatic network, leading to obstruction of lymphatic pathways and impaired fluid return. Persistent lymphatic obstruction increases vessel pressure, promoting fibroblast proliferation and collagen deposition, which result in lymphatic vessel thickening, sclerosis, and functional loss. Fibrotic changes in surrounding tissues further disrupt lymphatic function, causing skin and subcutaneous tissue hardening, characteristic of lymphedema. Clinically, this manifests as swelling, chronic inflammation, tissue fibrosis, and fat deposition in the affected limb [8, 9]. Symptoms such as soreness, swelling, numbness, pain, and heaviness significantly impair patients’ quality of life, contributing to sleep disturbances, anxiety, and depression [9–11]In severe cases, BCRL can lead to limb dysfunction, deformity, or even disabling amputation, posing life-threatening risks. Given the lack of curative treatments for BCRL, understanding and mitigating its risk factors are critical for prevention [12].
Body mass index (BMI) is a significant risk factor for postoperative lymphedema in breast cancer patients, with over 50% of these patients being overweight or obese [13–15]. Numerous studies have identified BMI as a contributing factor to lymphedema development [16–19]though conflicting findings exist [2, 20, 21]. This systematic review and meta-analysis aims to critically evaluate the literature on the association between BMI and postoperative lymphedema in breast cancer patients, with the goal of early identification of at-risk individuals to facilitate personalized treatment strategies.
Methods
Study objectives
The primary objective of this study was to assess the association between BMI and the OR of lymphedema in postoperative breast cancer patients.
Literature search strategy
We performed comprehensive electronic searches in PubMed, Embase, Web of Science, and the Cochrane Library using multiple keywords simultaneously. The search was restricted to clinical trials published in English. Three researchers (W.Z., Z.L., and J.L.) independently extracted data and evaluated potential bias. The search period extended until October 7, 2024. Article screening was conducted independently by two evaluators based on predefined NAE criteria. Discrepancies between evaluators were resolved through re-examination by a third evaluator to achieve consensus. Initially, 1465 articles were identified. After excluding 420 articles based on title and abstract, 30 non-English articles, non-clinical trials, and articles lacking sample sizes or OR, and removing 999 duplicates, 16 studies were ultimately included in this meta-analysis.
Inclusion and exclusion criteria
Inclusion criteria: (1) Published clinical studies in English; (2) Female patients aged 18–85 years; (3) Patients diagnosed with primary breast cancer who underwent surgical intervention; (4) Classification of BMI as a dichotomous variable.
Exclusion criteria: (1) Reviews, meta-analyses, editorials, commentaries, or case reports; (2) Studies focusing on benign breast tumors or metastatic disease; (3) Cases of lymphedema induced by non-surgical causes or primary lymphedema.
Statistical analysis
The following data were extracted from each study: first author’s name, publication year, study design, country, surgical procedure, sample size, follow-up duration, and the definition and measurement method of lymphedema. Evaluations and subgroup analyses were performed using OR and 95% CI. A random-effects model was applied when P < 0.01 or the I² statistic indicated heterogeneity exceeding 50%; otherwise, a fixed-effects model was used. Data were organized using Microsoft Excel and analyzed using Review Manager version 5.4 (Cochrane Collaboration) for forest plot generation. Sensitivity analyses were conducted by sequentially excluding individual studies to evaluate their impact on the overall estimates. Publication bias was assessed using the Egger test. (Supplementary Fig. 1). Sensitivity analyses demonstrated that no single study significantly influenced the cumulative OR, indicating robust statistical stability and reliability of the pooled results (data not shown). The meta-analysis reports substantial heterogeneity (I² = 78%), Egger’s test identified significant heterogeneity sources (P < 0.05): (1) non-circumferential measurement.(Supplementary Fig. 2.) (2) geographic regions (Asia, North America) (Supplementary Fig. 3.and 4.) .This suggests that measurement variability contributes to outcome discrepancies, underscoring the need for standardized diagnostic criteria. Regional heterogeneity implies that BMI cutoff values should be race-specific, while differential surgical practices may partially modulate BMI-associated risks.
Results
Characteristics of the included studies
A comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library yielded 466 records, including studies, international conference reports, and reviews. After removing duplicates, 46 articles were identified as relevant. Following the application of exclusion criteria, 16 studies were deemed eligible for inclusion in this meta-analysis (Fig. 1) [2, 20–34]. The combined sample size across all studies was 6,057, with individual study sample sizes ranging from 101 to 1,130. Key characteristics and methodologies of the included studies are summarized in Table 1. Among the 16 studies, 11 provided relevant OR data, while the remaining studies reported sample sizes for experimental and control groups. One study with BMI classifications of < 24 kg/m² and ≥ 24 kg/m², and two studies with BMI classifications of < 26 kg/m² and ≥ 26 kg/m², were reclassified into the < 25 kg/m² and ≥ 25 kg/m² groups for consistency. Notably, one article presented OR with the control group compared to the upper BMI category (≤ 26 > 26 kg/m²); thus, sample sizes were extracted, and OR were recalculated using Review Manager version 5.4.Subgroup analyses were conducted based on geographic regions: 9 studies focused on patients in Asia, 5 in Europe, and 2 in North America. Consequently, regional subgroups were categorized as Asia, Europe, and North America for further analysis. Subgroup analyses were performed according to Lymphedema measurement methods: 13 studies were analyzed in non-circumferential measured Lymphedema assessment methods and 3 studies were analyzed in circumferential measurement measured Lymphedema assessment methods. Lymphedema assessment methods across studies were categorized as: (1) circumferential measurements, (2) self-report, (3) Tape measure, (4) Cone model and (5) medical record documentation.
Fig. 1.
Search strings and flowcharts for filtering and research selection
Table 1.
Main characteristics of included in the present meta-analysis
Statistical significance was stated in the case of p < 0.05 and was highlighted by light gray color
Main analyses
Meta-analysis of the 16 included studies revealed that patients with a BMI ≥ 25 kg/m² had a significantly higher risk of developing postoperative breast cancer-related lymphedema compared to those with a BMI < 25 kg/m², with an OR of 2.05 (95% CI, 1.53–2.75; P < 0.005; I² = 78%). This finding indicates that overweight or obese patients (BMI ≥ 25 kg/m²) are at a statistically significant increased risk of postoperative lymphedema, as illustrated in Fig. 2. (Supplementary Fig. 5.)
Fig. 2.
Forest plots for the effect of BMI ≥ 25 kg/m2 group versus BMI < 25 kg/m2 group
Subgroup analyses(regional subgroup)
Subgroup analysis revealed that the OR for the nine Asian studies comparing BMI ≥ 25 kg/m² to BMI < 25 kg/m² was 2.19 (95% CI, 1.44–3.33; P < 0.05; I² = 82%), as depicted in Fig. 3. For the five North American studies, the OR was 1.75 (95% CI, 1.03–2.99; P = 0.04), as shown in Fig. 4. In the two European studies, the OR was 2.39 (95% CI, 1.47–3.90; P < 0.05), as illustrated in Fig. 5. These findings indicate that overweight or obese patients (BMI ≥ 25 kg/m²) in Asia, Europe, and North America exhibit a significantly higher risk of developing postoperative breast cancer-related lymphedema compared to normal or underweight patients.
Fig. 3.
Forest plot of the impact of BMI ≥ 25 kg/m2 group versus BMI < 25 kg/m2 group on breast cancer patients in Asia, analyzed by subgroups of region type
Fig. 4.
Forest plot of the impact of the BMI ≥ 25 kg/m2 group versus the BMI < 25 kg/m2 group on breast cancer patients in North America, analyzed by subgroup of region type
Fig. 5.
Forest plot of the impact of the BMI ≥ 25 kg/m2 group versus the BMI < 25 kg/m2 group on breast cancer patients in the European region, analyzed by subgroup of region type
Subgroup analyses (Lymphedema measurement method subgroup)
Subgroup analyses showed differential associations between BMI and risk of lymphedema based on lymphedema assessment methods (Supplementary Fig. 6–7.). In studies using circumferential measurement (n = 3), the combined odds ratio (OR) for BMI ≥ 25 kg/m² versus < 25 kg/m² was 2.42 (95% CI: 0.60–9.82; P = 0.22). In contrast, studies using non-circumferential measurement methods (n = 13) showed a statistically significant increase in risk (OR = 2.01, 95% CI: 1.47–2.74; P < 0.05). These results suggest that overweight/obese patients (BMI ≥ 25 kg/m²) with a diagnosis of lymphedema using non-circumferential measurement have a significantly higher risk of postoperative breast cancer-associated lymphedema compared with normal/underweight patients.
Discussion
In this study, we conducted a meta-analysis to evaluate the relationship between BMI and postoperative lymphedema in breast cancer patients. Our results demonstrated a significant association between elevated BMI and an increased risk of postoperative lymphedema. These findings align with those of Bolette S. Rafn et al. (2022) and Ruxing Wu et al. (2019), both of whom reported that higher BMI is a risk factor for lymphedema [8, 15]. However, studies such as Li Zou et al. (2018) and Sungmin Park et al. (2018) did not identify a significant correlation between BMI and lymphedema [20, 21]. Unlike previous analyses, this study focused exclusively on postoperative breast cancer patients and categorized BMI dichotomously at 25 kg/m². A key strength of this meta-analysis is the inclusion of studies from diverse geographic regions, providing a large and highly representative sample size, thereby enhancing the external validity of the findings. Additionally, subgroup analyses were conducted to explore regional differences, offering further insights into the variability in postoperative lymphedema risk among populations from different regions.
Lymphedema is characterized by the accumulation of lymphatic fluid in the extracellular space due to disruption of the lymphatic system, which obstructs lymphatic return pathways and prevents the central flow of lymphatic fluid from the distal limbs, leading to the accumulation of protein-rich fluid in soft tissues [35]. This condition is primarily attributed to lymphatic injury during surgical procedures [36]. Studies have demonstrated that surgery disrupts the upper extremity lymphatic system, resulting in an average decrease in lymphatic flow, which can increase the risk of lymphedema [37]. The mechanism by which obesity contributes to lymphedema remains unclear, though several hypotheses have been proposed. Elevated BMI may promote lymphedema through increased body fat accumulation, which can compress and obstruct the lymphatic system, impairing lymphatic fluid flow and exacerbating the burden on lymphatic return [38–40]. Elevated BMI may compromise microvascular lymphatic grafts by promoting perivascular fibrosis and impairing endothelial function, as evidenced by reduced lymphatic vessel density in obese patients (Florian S Frueh2022) [41]. Additionally, chronic inflammation associated with obesity may cause abnormal dilation of lymphatic vessels and reduction in lymph node size, further impairing lymphatic function and facilitating the development of lymphedema [6, 12]. This underscores the need for weight management in high-risk surgical candidates. Recent studies (including the AMAROS trial and the Naoum et al. 2023 study) have shown that while surgery remains a major risk factor, lymph node radiotherapy is also a major influence on the risk of lymphedema. Fatty inflammation may affect lymphatic regeneration after radiotherapy and exacerbate radiation-related lymphatic injury, patients with high BMI may require extended radiotherapy to ensure adequate axillary coverage, and fibrosis in the area of radiotherapy may superimpose lymphatic dysfunction associated with patients with high BMI, indirectly exacerbating the risk of lymphedema by increasing the technical difficulty of radiotherapy (e.g., target area coverage). Due to the limited data reported for radiotherapy fields in the included studies, this analysis was unable to fully assess the potential interaction between BMI and lymph node radiotherapy. Future prospective studies should evaluate whether BMI-specific radiotherapy strategies (e.g., adjusting field boundaries or dose) can reduce the risk of lymphedema in obese patients [42].
Given the significant association between BMI and postoperative lymphedema, clinicians should incorporate BMI as a critical factor in assessing the risk of lymphedema during the management of breast cancer patients. BMI demonstrates significant cost-effectiveness as a screening tool for breast cancer-related lymphedema (BCRL), particularly in resource-limited settings. Unlike advanced diagnostic modalities (e.g., bioimpedance spectroscopy), BMI requires no specialized equipment or additional training, enabling widespread implementation in primary care and oncology follow-up. By facilitating early identification of high-risk patients, BMI-based screening may reduce long-term healthcare costs associated with advanced lymphedema complications requiring intensive therapies (e.g., complex decongestive therapy). This approach not only identifies at-risk individuals but also directs targeted preventive interventions, thereby enhancing the value of routine postoperative surveillance. Emerging evidence suggests a shift in focus from manual lymphatic drainage to early diagnosis, compression therapy, weight management, and exercise to enhance strength and circulation. Notably, study demonstrated that structured weight loss programs (e.g.: diet, exercise) significantly reduced lymphedema incidence, supporting proactive interventions in obese patients [43]. Healthcare providers shuld educate overweight and obese patients about their elevated risk of lymphedema, offering practical dietary guidance and encouraging physical activity to mitigate this risk. Early intervention is essential upon diagnosis of BCRL. In summary, a thorough understanding of BCRL risk factors allows healthcare professionals to refine patient care and rehabilitation strategies. By identifying and proactively addressing these factors, the long-term physical burden of lymphedema can be minimized, ultimately improving the quality of life for breast cancer survivors. Although BCRL is incurable, symptoms can be alleviated through aggressive decongestive therapy, specialized nursing care, and sustained rehabilitation, while also addressing the long-term social and psychological needs of patients.
A key strength of this meta-analysis lies in its integration of multiple studies from diverse geographic regions, providing a large and highly representative sample size. The inclusion of data from various regions enhances the generalizability of the findings by encompassing a broader population and diverse demographic characteristics. Furthermore, the diversity of the studies helps mitigate potential biases that may arise from region-specific research. The substantial sample size also strengthens the statistical power and inferential robustness of the results, enabling a more precise assessment of the relationship between the variables. This methodological rigor significantly enhances the external validity of the study, thereby increasing the credibility and reliability of the findings.
Our study has several limitations. First, the inclusion of only English-language studies may have excluded relevant literature on the same topic published in other languages, potentially introducing language bias. Second, all data were derived from published literature, and individual patient-level data were not utilized, which may introduce bias into the meta-analysis results. Third, the majority of the included studies were retrospective in design. Retrospective studies are prone to underestimating the incidence of latent lymphedema cases due to the lack of systematic edema assessment. While prospective studies avoid many of these issues, they often suffer from inconsistent definitions and measurement methods for lymphedema. As our study is retrospective, it may be subject to similar limitations. Fourth, Our study has important limitations regarding confounding factors.While BMI was the primary exposure, key variables including surgical extent (ALND vs. SLNB), adjuvant therapies, lifestyle factors, and comorbidities (e.g., diabetes) were inconsistently adjusted across studies. These factors may independently affect lymphatic function and interact with BMI. Notably, diabetes may exacerbate microvascular damage while ALND increases lymphatic trauma. The absence of individual patient data precluded comprehensive multivariable adjustment. variability in BMI measurement methods across the included studies may have contributed to heterogeneity in the results. Additionally, many studies did not control for all potential confounding variables, such as physical activity levels and dietary habits, which could simultaneously influence the relationship between BMI and lymphedema. Consequently, our findings may not fully represent the disease progression characteristics in all patients, potentially affecting the interpretation of the results. Fifth, Among the included studies, only 18.8% (n = 3/16) employed objective volumetric assessment methods (Petrek et al., 2001; Soyder et al., 2014; Huang et al., 2012), while the majority relied on subjective reporting. This methodological heterogeneity in lymphedema assessment may introduce diagnostic bias and affect the comparability of outcomes across studies. However, the use of rigorously aggregated data and robust statistical methods in our analysis helps mitigate these biases. Despite these limitations, our findings underscore that obese and overweight patients (BMI ≥ 25 kg/m²) are at an increased risk of developing postoperative lymphedema following breast cancer surgery, offering valuable insights for clinical practice. Future research should aim to standardize BMI measurements and incorporate additional potential influencing factors, such as diet and exercise, to further elucidate the relationship between BMI and postoperative lymphedema. Longitudinal studies are also needed to establish causal relationships between BMI and lymphedema.
Conclusions
This meta-analysis confirms that obesity and overweight status (BMI ≥ 25 kg/m²) are significant risk factors for lymphedema following breast cancer surgery. Healthcare professionals should provide comprehensive education to breast cancer survivors, particularly those at high risk of developing lymphedema, to enable early detection of adverse physical changes. Such proactive measures can facilitate timely intervention, potentially preventing the onset of lymphedema and mitigating its associated complications.
Supplementary Information
Author contributions
WWZ and ZLL: Conceptualization, Writing – original draft, Writing – review & editing. JML, HHZ and PY: Writing – review & editing. TW, MJW and GSS: Formal analysis. FXZ and ZL was responsible for the decision to submit the manuscript. All authors read and approved the final version of the manuscript.
Funding
This work has been supported by the “Kunlun Talent High end Innovation and Entrepreneurship Talent” project in Qinghai Province in 2023.
Data availability
Data are available from the corresponding author on request.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Weiwei Zhang, Zhilin Liu and Jinming Li contributed equally to this work.
Contributor Information
Fuxing Zhao, Email: 18797349621@163.com.
Zhen Liu, Email: qhdxlz@163.com.
References
- 1.Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A, Cancer Statistics. 2025. CA. Cancer J. Clin. 2025, 75 (1), 10–45. 10.3322/caac.21871 [DOI] [PMC free article] [PubMed]
- 2.Hara Y, Otsubo R, Shinohara S, Morita M, Kuba S, Matsumoto M, Yamanouchi K, Yano H, Eguchi S, Nagayasu T. Lymphedema after axillary lymph node dissection in breast cancer: prevalence and risk Factors-A Single-Center retrospective study. Lymphat Res Biol. 2022;20(6):600–6. 10.1089/lrb.2021.0033. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Basta MN, Fischer JP, Kanchwala SK, Silvestre J, Wu LC, Serletti JM, Tchou JC, Kovach SJ, Fosnot JA. Propensity-Matched analysis of the influence of breast reconstruction on subsequent development of lymphedema. Plast Reconstr Surg. 2015;136(2):e134–43. 10.1097/PRS.0000000000001417. [DOI] [PubMed] [Google Scholar]
- 4.Fourgeaud C, Vignes S. New insights in breast Cancer-Related lymphedema. J Med Vasc. 2024;49(3–4):135–40. 10.1016/j.jdmv.2024.06.001. [DOI] [PubMed] [Google Scholar]
- 5.Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GKD, Scott-Conner C. Lymphedema following breast cancer: the importance of surgical methods and obesity. Front Womens Health. 2018;3(2). 10.15761/FWH.1000144. [DOI] [PMC free article] [PubMed]
- 6.Basta MN, Wu LC, Kanchwala SK, Serletti JM, Tchou JC, Kovach SJ, Fosnot J, Fischer JP. Reliable prediction of postmastectomy lymphedema: the risk assessment tool evaluating lymphedema. Am J Surg. 2017;213(6):1125–e11331. 10.1016/j.amjsurg.2016.08.016. [DOI] [PubMed] [Google Scholar]
- 7.Naoum GE, Taghian AG. Regional lymph node radiation is not the main risk factor for breast cancer related lymphedema: stop chasing radiation doses, fractionation or Techniques-Focus on axillary surgery De-Escalation or prevention. Int J Radiat Oncol Biol Phys. 2023;117(2):461–4. 10.1016/j.ijrobp.2023.04.020. [DOI] [PubMed] [Google Scholar]
- 8.Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective surveillance for breast Cancer-Related arm lymphedema: A systematic review and Meta-Analysis. J Clin Oncol Off J Am Soc Clin Oncol. 2022;40(9):1009–26. 10.1200/JCO.21.01681. [DOI] [PubMed] [Google Scholar]
- 9.Zhu Y-Q, Xie Y-H, Liu F-H, Guo Q, Shen P-P, Tian Y. Systemic analysis on risk factors for breast cancer related lymphedema. Asian Pac J Cancer Prev APJCP. 2014;15(16):6535–41. 10.7314/apjcp.2014.15.16.6535. [DOI] [PubMed] [Google Scholar]
- 10.Heiney SP, McWayne J, Cunningham JE, Hazlett LJ, Parrish RS, Bryant LH, Vitoc C, Jansen K. Quality of life and lymphedema following breast cancer. Lymphology. 2007;40(4):177–84. [PubMed] [Google Scholar]
- 11.Pyszel A, Malyszczak K, Pyszel K, Andrzejak R, Szuba A, Disability. Psychological distress and quality of life in breast cancer survivors with arm lymphedema. Lymphology. 2006;39(4):185–92. [PubMed] [Google Scholar]
- 12.Sakorafas GH, Peros G, Cataliotti L, Vlastos G. Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol. 2006;15(3):153–65. 10.1016/j.suronc.2006.11.003. [DOI] [PubMed] [Google Scholar]
- 13.Fu MR, Axelrod D, Guth AA, Fletcher J, Qiu JM, Scagliola J, Kleinman R, Ryan CE, Chan N, Haber J. Patterns of obesity and lymph fluid level during the first year of breast cancer treatment: A prospective study. J Pers Med. 2015;5(3):326–40. 10.3390/jpm5030326. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118(8 Suppl):2277–87. 10.1002/cncr.27466. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Wu R, Huang X, Dong X, Zhang H, Zhuang L. Obese patients have higher risk of breast Cancer-Related lymphedema than overweight patients after breast cancer: A Meta-Analysis. Ann Transl Med. 2019;7(8):172. 10.21037/atm.2019.03.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ. Morbidity of Sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol. 2010;17(12):3278–86. 10.1245/s10434-010-1155-4. [DOI] [PubMed] [Google Scholar]
- 17.McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, Hurley KE, Riedel ER, Van Zee KJ. Prevalence of lymphedema in women with breast cancer 5 years after Sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26(32):5213–9. 10.1200/JCO.2008.16.3725. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Ahmed RL, Schmitz KH, Prizment AE, Folsom AR. Risk factors for lymphedema in breast cancer survivors, the Iowa women’s health study. Breast Cancer Res Treat. 2011;130(3):981–91. 10.1007/s10549-011-1667-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.McLaughlin SA, Wright MJ, Morris KT, Sampson MR, Brockway JP, Hurley KE, Riedel ER, Van Zee KJ. Prevalence of lymphedema in women with breast cancer 5 years after Sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26(32):5220–6. 10.1200/JCO.2008.16.3766. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Zou L, Liu F-H, Shen P-P, Hu Y, Liu X-Q, Xu Y-Y, Pen Q-L, Wang B, Zhu Y-Q, Tian Y. The incidence and risk factors of related lymphedema for breast cancer survivors Post-Operation: A 2-Year Follow-up prospective cohort study. Breast Cancer Tokyo Jpn. 2018;25(3):309–14. 10.1007/s12282-018-0830-3. [DOI] [PubMed] [Google Scholar]
- 21.Park S, Lee JE, Yu J, Paik H-J, Ryu JM, Kim I, Bae SY, Lee SK, Kim SW, Nam SJ, Kim E-K, Kang E, Yang EJ. Risk factors affecting breast Cancer-Related lymphedema: serial body weight change during neoadjuvant anthracycline plus cyclophosphamide followed by taxane. Clin Breast Cancer. 2018;18(1):e49–54. 10.1016/j.clbc.2017.06.003. [DOI] [PubMed] [Google Scholar]
- 22.Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368–77. [DOI] [PubMed] [Google Scholar]
- 23.Geller BM, Vacek PM, O’Brien P, Secker-Walker RH. Factors associated with arm swelling after breast cancer surgery. J Womens Health 2002. 2003;12(9):921–30. 10.1089/154099903770948159. [DOI] [PubMed] [Google Scholar]
- 24.Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: A Three-Year Follow-up study. QJM Mon J Assoc Physicians. 2005;98(5):343–8. 10.1093/qjmed/hci053. [DOI] [PubMed] [Google Scholar]
- 25.Swenson KK, Nissen MJ, Leach JW, Post-White J. Case-Control study to evaluate predictors of lymphedema after breast cancer surgery. Oncol Nurs Forum. 2009;36(2):185–93. 10.1188/09.ONF.185-193. [DOI] [PubMed] [Google Scholar]
- 26.Chen J-J, Huang X-Y, Liu Z-B, Chen T-W, Cheng J-Y, Yang W-T, Xu W-P, Shao Z-M, Shen Z-Z, Wu J. Sentinel node biopsy and quality of life measures in a Chinese population. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2009;35(9):921–7. 10.1016/j.ejso.2009.01.009. [DOI] [PubMed] [Google Scholar]
- 27.Crosby MA, Card A, Liu J, Lindstrom WA, Chang DW. Immediate breast reconstruction and lymphedema incidence. Plast Reconstr Surg. 2012;129(5):e789–95. 10.1097/PRS.0b013e31824a2ab1. [DOI] [PubMed] [Google Scholar]
- 28.Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast Cancer-Related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg. 2012;130(6):1169–78. 10.1097/PRS.0b013e31826d0faa. [DOI] [PubMed] [Google Scholar]
- 29.Hua-Ping H, Jian-Rong Z, Zeng Q. Risk factors associated with lymphedema among postmenopausal breast cancer survivors after radical mastectomy and axillary dissection in China. Breast Care Basel Switz. 2012;7(6):461–4. 10.1159/000345459. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Huang H-P, Zeng Q, Zhou J-R. Risk factors associated with lymphoedema among Chinese women after breast cancer surgery. Contemp Nurse. 2013;44(1):5–10. 10.5172/conu.2013.44.1.5. [DOI] [PubMed] [Google Scholar]
- 31.Ugur S, Arıcı C, Yaprak M, Mescı A, Arıcı GA, Dolay K, Ozmen V. Risk factors of breast Cancer-Related lymphedema. Lymphat Res Biol. 2013;11(2):72–5. 10.1089/lrb.2013.0004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Soyder A, Taştaban E, Özbaş S, Boylu Ş, Özgün H. Frequency of Early-Stage lymphedema and risk factors in postoperative patients with breast cancer. J Breast Health. 2014;10(2):92–7. 10.5152/tjbh.2014.1973. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Aoulad N, Massabeau C, de Lafontan B, Vieillevigne L, Hangard G, Ciprian C, Chaltiel L, Moyal É, Izar F. [Acute toxicity of breast cancer irradiation with modulated intensity by tomotherapy(®)]. Cancer Radiother J Soc Francaise Radiother Oncol. 2017;21(3):180–9. 10.1016/j.canrad.2016.11.008. [DOI] [PubMed] [Google Scholar]
- 34.Kim HK, Ju YW, Lee JW, Kim KE, Jung J, Kim Y, Lee HB, Moon HG, Noh DY, Seo KS, Han W. Association between number of retrieved Sentinel lymph nodes and breast Cancer-Related lymphedema. J Breast Cancer. 2021;24(1):63–74. 10.4048/jbc.2021.24.e9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Wang L, Chen H, Li Y, Wang H, Liu N, Yu M, Shang S. Body mass index increases the risk of breast cancer-Related lymphedema at 6–18 months after surgery: A retrospective study. Support. Care cancer off. J Multinatl Assoc Support Care Cancer. 2023;31(5):278. 10.1007/s00520-023-07721-7. [DOI] [PubMed] [Google Scholar]
- 36.Duma M-N. [Lymphedema risk in breast cancer patients: surgery versus radiation oncology]. Strahlenther Onkol Organ Dtsch Rontgengesellschaft Al. 2021;197(6):562–4. 10.1007/s00066-021-01762-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Naoum GE, Roberts S, Brunelle CL, Shui AM, Salama L, Daniell K, Gillespie T, Bucci L, Smith BL, Ho AY, Taghian AG. Quantifying the impact of axillary surgery and nodal irradiation on breast Cancer-Related lymphedema and local tumor control: Long-Term results from a prospective screening trial. J Clin Oncol. 2020;38(29):3430–8. 10.1200/JCO.20.00459. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Mak SS, Yeo W, Lee YM, Mo KF, Tse KY, Tse SM, Ho FP, Kwan WH. Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res. 2008;57(6):416–25. 10.1097/NNR.0b013e31818c3de2. [DOI] [PubMed] [Google Scholar]
- 39.Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast Cancer-Related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018;7(4):379–403. 10.21037/gs.2017.11.04. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Greene AK, Maclellan RA. Obesity-Induced upper extremity lymphedema. Plast. Reconstr Surg Glob Open. 2013;1(7):e59. 10.1097/GOX.0b013e3182a96359. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Frueh FS, Gassert L, Scheuer C, Müller A, Fries P, Boewe AS, Ampofo E, Rübe CE, Menger MD, Laschke MW. Adipose Tissue-Derived microvascular fragments promote lymphangiogenesis in a murine lymphedema model. J Tissue Eng. 2022;13:20417314221109957. 10.1177/20417314221109957. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Bartels SAL, Donker M, Poncet C. Radiotherapy or surgery of the axilla after a positive Sentinel node in breast cancer: 10-Year results of the randomized controlled EORTC 10981–22023 AMAROS trial. J Clin Oncol. 2023;41(12):2159–65. 10.1200/JCO.22.01565. [DOI] [PubMed] [Google Scholar]
- 43.Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast Cancer-Related lymphedema. Cancer. 2007;110(8):1868–74. 10.1002/cncr.22994. [DOI] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Data Availability Statement
Data are available from the corresponding author on request.