Role of Axillary Reverse Mapping in the Prevention of Lymphedema after Modified Radical Mastectomy in Breast Cancer

Lymphedema is a well-established complication of modified radical mastectomy (MRM). Axillary reverse mapping (ARM) can help spare the upper limb lymph nodes thus preventing lymphedema. This study assessed the role of ARM in lymphedema prevention after MRM.

Breast cancer patients eligible for MRM were included and divided into two groups of 50 patients each. Group A underwent ARM with MRM and Group B underwent MRM only. Follow-up was done at 3 months, 6 months, and 1 year to assess for lymphedema. Preoperative and postoperative arm circumference was compared and statistically analyzed.

Mean number of lymph nodes removed in ARM group (11.42 ± 1.349) was significantly lower than that in the non-ARM group (12.67 ± 1.786), P = 0.0088. Mean number of lymph nodes stained in the ARM group was 8.042 ± 1.083. The mean ± standard deviation of arm width difference for the ARM group at follow-ups was 1.408 ± 0.7283, 1.521 ± 0.6878, and 1.750 ± 1.750 cm and 1.450 ± 0.7830, 1.588 ± 0.7503, and 1.863 ± 0.9021 cm in non-ARM group indicating that the arm width difference in the ARM group was consistently lower than that of the non-ARM group at each follow-up, P > 0.05.

Arm width difference was less in the ARM group as compared to the non-ARM group at serial follow-ups. Hence, ARM reduces the severity of lymphedema but does not completely prevent it. It is difficult to make it a routine due to lymphatic cross over and incomplete oncologic clearance. Proper case selection is needed to derive the benefit of ARM.