Rehabilitation as Prevention of Secondary Fibrosis in Postmastectomy Lymphedema with Axillary Lymphadenectomy

Abstract

Introduction

Breast cancer is the most common cancer worldwide, with 2.3 million cases annually globally, and in Mexico it is the leading cause of cancer in women (1,2). Mastectomy with axillary lymph node dissection is indicated in locally advanced tumors or those with lymph node involvement, occurring in 30-40% of these cases. Post-mastectomy lymphedema affects up to 30-50% of patients who undergo lymph node dissection. Chronic inflammation mediated by TGF-β1, IL-6, and TNF-α promotes progression to progressive tissue fibrosis. Comprehensive rehabilitation is key, using manual lymphatic drainage, therapeutic exercises, compression bandaging, and specialized physical therapy, to prevent associated sequelae such as fibrosis and functional impairment.

Objective

To evaluate the preventive role of early rehabilitation in preventing inflammatory progression and fibrosis associated with lymphedema and chronic pain in women with breast cancer who have undergone mastectomy with axillary lymph node dissection.

Methodology

A systematic review was conducted following the 2009 PRISMA guidelines. The search was performed in PubMed, Scopus, the Cochrane Library, and the digital libraries of the UAM and UNAM, including articles published between 2020 and 2025 in Spanish and English. Boolean search terms were used, selecting the most recent reviews on each topic.

Inclusion criteria included studies on rehabilitation in breast cancer patients with lymphedema, fibrosis, or pain. Studies in other populations, those without full text, or those with bias were excluded.

Results

The main rehabilitation strategies for post-mastectomy lymphedema include manual lymphatic drainage, which reduces arm volume by up to 30%, and multilayer compression bandaging, which decreases volume by 12% to 23% and reduces recurrence by 50% annually. Intermittent compression therapy achieves reductions of 10% to 18%, while low-level laser therapy combined with kinesiotaping provides an additional 8% to 12% reduction.

Daily therapeutic exercises for 12 weeks improve quality of life in more than 60% of patients, and aquatic exercise combined with neuromuscular electrical stimulation increases strength and reduces volume by 6%. Combining these techniques within a comprehensive protocol is essential to prevent the progression of lymphedema and its functional and psychosocial consequences.

Conclusions

Comprehensive rehabilitation prevents the progression of lymphedema to tissue fibrosis by modulating chronic inflammation.

The key inflammatory mediators involved are TGF-β1, IL-6, IL-1β, and TNF-α, which are responsible for progressive fibrosis.

The combination of techniques such as manual lymphatic drainage, compression bandaging, pressotherapy, low-level laser therapy, kinesiotaping, therapeutic exercises, aquatic therapy, and neuromuscular electrical stimulation achieves a 30–35% reduction in lymphedema volume.

These strategies decrease lymphedema recurrence by 50% and improve functionality.
A structured and sustained multidisciplinary rehabilitation approach is essential to control lymphedema, prevent fibrosis, avoid functional decline, and mitigate its psychosocial impact.