Evolution Of Subclinical Systemic Lymphedema In-Patient With Lipedema And Axillary Dissection

Abstract

Background: The surgical treatments of breast cancer associated or not with axillary drainage and radiotherapy constitute the main cause of secondary upper limb lymphedema. Obesity is a particularly aggravating aspect in patients with lymphedema. Novel concepts of subclinical systemic lymphedeman and clinical systemic lymphedema have recently been described. The aim of the present study was to evaluate the evolution of subclinical systemic lymphedema to upper limb lymphedema following treatment for breast cancer. Case: A 36-year-old female patient had been submitted to treatment for breast cancer involving left-side mastectomy and lymph node drainage during a pregnancy three years earlier. She had undergone both chemotherapy and radiotherapy. The patient had a portacath in the right arm for chemotherapy, which was removed after the first evaluation. She was submitted to bioelectrical impedance analysis, which revealed an increase in intracellular and extracellular water and body water in all limbs and the trunk above the normal range. The patient returned approximately two years after the initial evaluation, complaining of edema in the left arm. Conclusion: The treatment of breast cancer in patients with lipedema could lead to the development of subclinical lymphedema in patients with a BMI less than 30 kg/m². Therefore, such conditions constitute a warning sign for the development of lymphedema.