Axillary reverse mapping for prevention of postmastectomy lymphedema: a randomized controlled trial

Ibrahim, Mohammed Hatem; Zaghloul, Nasser; Abogazea, Osama Mohammed; Attia, Ahmed; Hamza, Hossam Mohamed

doi:10.21608/mjmr.2025.404678.2034

Axillary reverse mapping for prevention of postmastectomy lymphedema: a randomized controlled trial

Articles in Press

Document Type : Original Article

Authors

¹ General surgery department, Faculty of Medicine, Minia University, Minia, Egypt

² General Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt.

³ Department of Surgical Oncology, Al-Maadi military compound, Cairo, Egypt.

⁴ General surgery department, Faculty of Medicine, Minia University Minia,Egypt

10.21608/mjmr.2025.404678.2034

Abstract

Background: Lymphedema is a serious complication of breast cancer treatment that greatly impacts quality of life. To prevent it, axillary reverse mapping (ARM) is used, which involves injecting blue dye into the arm to identify the lymph channels and nodes.

Objectives: To assess ARM's effectiveness in reducing post-mastectomy complications after axillary clearance surgery in breast tumors using methylene blue dye.

Methods: This prospective randomized controlled trial comprised 40 breast tumor cases who consented to breast conservative operation and modified radical mastectomy, divided into 2 equal groups: group A: mastectomy with ARM, and group B: mastectomy without ARM as controls. Follow-up visits were at three, six, and twelve months after mastectomy to assess postoperative complications, tumor recurrence, and development of lymphedema.

Results: statistically significant variance among groups concerning post-operative lymphedema. The mean time of lymphedema appearance during post-operative follow-up was after 3 months. The mean range of increase in mid-arm circumference in the ARM group was 0.8 ±0.7 cm, whereas in group B was 1.05±0.89, with no statistical significant variance (p=0.429). A significant reduction was shown in mid arm circumference in group A in comparison with group B at all follow-ups. The mean number of identified LNs in the specimen of group A was 12.3±2.25, whereas in group B it was 12.35±2.06, with no statistically significant variance (p-value equal to 0.026).

Conclusion: When compared to traditional axillary lymph-node dissection operation, the use of axillary reverse mapping was linked to a decreased frequency of arm lymphedema in the group that we studied.

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