Breast Edema in Women With Arm Lymphedema Following Breast-Conserving Surgery: A Systematic Review

Breast edema is a clinically significant but underrecognized complication following breast-conserving surgery (BCS) and radiotherapy. It involves parenchymal and cutaneous changes that can cause pain, functional impairment, and reduced quality of life. Despite overlapping risk factors and shared lymphatic pathophysiology with breast cancer-related lymphedema (BCRL), breast edema remains poorly defined, with no standardized diagnostic criteria and wide variability in reported incidence. In contrast to the extensive literature on arm lymphedema, breast edema, particularly in patients who develop BCRL, has not been systematically synthesized. A clearer understanding of this relationship is needed to improve recognition, diagnosis, and clinical management. This systematic review aims to analyze the association between breast edema and BCRL, focusing on the development of breast edema and its quantitative diagnostic criteria following BCS. Three databases (Ovid MEDLINE, EMBASE, and Web of Science) were searched for studies pertaining to breast edema and arm lymphedema following BCS. Studies underwent a multistep screening process to ensure they met the inclusion criteria before inclusion in this systematic review. To be included in this review, studies must have been peer-reviewed, published between 2015 and 2025, written in the English language, and relevant to the topic of breast cancer-related lymphedema following BCS. A total of 23 studies met our inclusion criteria, representing 10,402 women across 14 countries who underwent BCS. The prevalence of breast edema varied widely, ranging from 2.7% to 24.8% in clinically assessed cohorts and up to 72% in ultrasound (US)-based studies. Breast edema was more frequently observed following axillary lymph node dissection, larger breast volume, higher body mass index (BMI), postoperative cellulitis, and in patients with BCRL. Women with breast edema reported worse quality of life, greater breast pain, and poorer body image. Quantitative assessment methods, including US and tissue dielectric constant (TDC) measurements, identified both clinical and subclinical breast tissue changes, though diagnostic thresholds and assessment approaches varied substantially across studies. Overall, this review illustrates multiple factors that contribute to breast edema and arm lymphedema, yet also points to the need to improve assessment measures to both identify and prevent edema following BCS.