Lymph taping and seroma formation post breast cancer
Clinical RESEARCH/AUDITLymph taping and seromaformation post breast cancer Joyce Bosman, Neil Piller Abstract Background: The most common complication of breast cancer treatment is seroma formation. Lymph taping has the potential to prevent or reduce seroma formation, but currently its potential benefits have not been fully investigated. Aims: To investigate the potential of lymph taping to combat seroma formation. Methods: Nine women treated for breast cancer were recruited to this randomised clinical trial; four developed seromas requiring aspiration. Bio-impedance spectroscopy of the breast was used to assess intra and extracellular fluid levels in each of the four quadrants of the breast. From day one postoperatively, lymph taping was applied over the watershed between skin territories on the posterior thorax between the spine and axilla on those allocated to the treatment group. Measurements were repeated at five, nine and 16 days. Results: The extracellular fluid value at t16 was 0.1037 ± 0.0324 (15.3 % decrease) over t1 in the lymph taping group and 0.1066 ± 0.0227 (4.6 % decrease) in the current best practice group (n=4 in each group). After 16 days of treatment, substantial changes were found in burning sensations, tightness and heaviness in favour of the lymph taping group. In particular, pain perception in the lymph taping group improved. Conclusions: This study has demonstrated that lymph taping has the ability to reduce extracellular fluid accumulation and improve a range of quality of life measures. seroma formation after breast surgery of the investigated criteria suggested Key words varies between 2.5% and 51% (Brayant that: and Baum, 1987; Barwell et al, 1997; 8 Seroma is not an accumulation of Breast cancer Woodworth et al, 2000). Vitug and serum, but an exudate Lymphoedema Newman (2007) report that 10% to 8 Exudate is an element in an acute Seroma formation 80% of ALND and mastectomy cases inflammatory reaction, i.e. the first Lymph taping require seroma aspiration. phase of wound repair 8 Seroma formation reflects Various methods have been an increased intensity and a used to prevent seroma formation. prolongation of this repair phase. However, the use of lymph tapingB reast cancer surgery is treated in this context has not been fully Watt-Boolsen et al (1989) also with either modified radical evaluated in the current literature. posited that the predominant white mastectomy (MRM), wide local cells present in a seroma wereexcision (WLE) and axillary lymph Seroma granulocytes rather than lymphocytes,node dissection (ALND), or sentinel Seroma is defined as a serous fluid indicating that the fluid is likely to belymph node biopsy (SLNB). Common collection that develops under the exudate. The protein concentrationcomplications of breast surgery skin flaps during mastectomy or in in seromas was found to be moreinclude bleeding, infection, lymph the axillary dead space after axillary consistent with that of an exudateoedema and nerve damage (Leica and dissection (Pogson et al, 2003). produced as a result of acuteApantaku, 2002). The most common Seroma formation generally begins on inflammation during wound healingcomplication following breast surgery the seventh day post surgery, reaches (Watt-Boolsen et al, 1989).is seroma formation. Incidence of a peak rate of growth on the eighth day and slows continuously until Gardner et al (2005) suggests the sixteenth day when it generally that there are seven causative factorsJoyce Bosman is an oedematherapist at Medisch Centrum resolves (Menton and Roemer, 1990). contributing to seroma formation:Zuid, Groningen, the Netherlands; Neil Piller is a Professor 8 Poor adherence of flaps toand Director of the Lymphoedema Assessment Clinic, Watt-Boolsen et al (1989) found chest wallDepartment of Surgery, Flinders University and Medical that the composition of the fluid and 8 Division of several larger lymphCentre, South Australia aspirates and the time-related changes trunks ?? Journal of Lymphoedema, 2010, Vol 5, No 2
Clinical RESEARCH/AUDIT8 Large dead space/large raw area in when symptomatic (Anand et al, immobilisation of the shoulder until the axilla 2002). In some cases, the fluid day seven postoperatively significantly8 Pump action of upper limb collection may recur so this may need reduced the incidence of seroma. increasing lymph flow to be done more than once (Cancer However, other authors describe8 Local inflammatory mediators, Society of New Zealand, 2003). how immobilisation of the upper8 Irregular shape of chest wall Seromas can generally be managed by limb generated unacceptable rates of and axilla one to six aspirations (Gonzalez et al, frozen shoulder and, therefore, advise8 Shear forces during respiration. 2003). However, the use of fine needle early shoulder exercises. Evidence for a aspiration to assess changes in an clear role of immobilisation in seroma Although seromas are not life- oedematous breast can be problematic prevention is still lacking (Gardner etthreatening, they can lead to significant and may, in itself, produce additional al, 2005).morbidity (e.g. flap necrosis, wound inflammation and oedema (Williams,dehiscence, predisposition to sepsis, 2006). Postoperative breast seroma,impaired shoulder function [muscle therefore, is an important cause ofstrength weakness], prolonged morbidity that continues to causerecovery period and multiple physician Although seromas are difficulties for surgeons and for whichvisits) and may delay adjuvant therapy not life-threatening, they the best treatment has long been(Budd et al, 1978; Aitkin and Minton, can lead to significant debated (Gardner et al, 2005).1983; Gardner et al, 2005). morbidity (e.g. flap The use of taping for the Extensive dissection generates a necrosis, wound dehiscence, management of seroma is gainingconsiderable potential space as breast predisposition to sepsis, popularity and while there is significanttissue is removed and lymphatic impaired shoulder clinical experience of this approach,vessels are severed allowing lymph function [muscle strength there is little published research.to pass into the dead space. The weakness], prolonged Lymph taping is a part of the Medicaldistensibility of the skin flaps raised Taping Concept, which is believed recovery period andduring the surgery further establishes to contribute to the stimulation anda potential space in which fluid can multiple physician visits) improvement of lymphatic drainagecollect. In addition, axillary lymph node and may delay adjuvant (www.medicaltaping.com).dissection results in the division of therapy.several larger lymph trunks, and when Lymph tapingthe arm is mobilised post-operatively, In its most common application,the upper-limb musculature acts as a Several interventions have been lymph taping is applied to the poorlypump, increasing lymph flow (Gardner reported with the aim of reducing draining area (lymphatic territory) ofet al, 2005). seroma formation including the use the lymphoedematous limb or area. of pressure garment and prolonged The special tape used has an elasticity It is common for people who have limitation of arm activity. However, it similar to that of the skin and is similarhad their lymph nodes removed to has been suggested that the use of in weight to the epidermis. By applyingexperience fullness under the arm these interventions not only reduces the tape in a proximal to distalafter the drain(s) has been removed. seroma formation, but may also direction and positioning the body inEvidence on the effect of drains on increase the incidence of seroma a way that the tape is stretched duringseroma formation is inconclusive formation after removal of the drain application, the lymphatic drainage(Gardner et al, 2005). People often (O’Hea et al, 1999), and even might system is stimulated 24 hours a day.describe seroma as like ‘having a ball cause shoulder dysfunction (Dawsonfixed into their armpit’. et al, 1989). The tape must be applied in accordance with the anatomy of Following a modified radical Seroma formation after breast the lymph flow. The tape lifts themastectomy it is also possible to cancer surgery occurs independently skin slightly, opening the lumen ofdevelop seroma on the chest wall. of drainage duration, compression the lymph angioma and reducingAs with a haematoma, this fluid is dressing and other known prognostic the pressure on the blood vessels.reabsorbed by the body over time. factors in breast cancer patients Moreover, the tape acts as a conductor except the type of surgery, i.e. there of interstitial fluid, moving fluids from Persistent seromas have is a 2.5 times higher risk of seroma areas of higher pressure towardstraditionally been treated with formation in patients who undergo areas of lower pressure (Kase et al,repeated aspirations, local pressure a modified radical mastectomy 2003). The tape may also influencedressings, and occasionally surgical compared to breast-conserving the deeper lymphatic system andablation (Gardner et al, 2005). surgery (Hashemi et al, 2004). Schultz encourage myofascial release,Seromas should only be aspirated et al (1997) were able to show that enhancing drainage in the subfascial Journal of Lymphoedema, 2010, Vol 5, No 2 ??
Clinical RESEARCH/AUDITlymphatics (although this remains to Flinders University and Medical Centre performed, tumour size, numberbe proven). Clinical Research Ethics Committee of lymph nodes removed, number prior to commencing the study. of lymph nodes infiltrated and the Shim et al (2003) posit that frequency and number of aspirations.endothelium may act as a micro-valve Nine women who had undergone Bio-impedance and QoL wasalong the walls of the initial lymphatics. surgical treatment for their measured on day one postoperativelyThese valves open during any breast cancer (± radiotherapy ± (t1), day five postoperatively (t5), daystretching of the lymphatics and during chemotherapy) were recruited for nine postoperatively (t9) and day 16the influx of interstitial fluid into the this clinical trial. Before surgery (t0), postoperatively (t16).lumen, while anchoring filaments keep participants were measured using bio-the endothelial cells tightly attached impedance spectroscopy and filled outto the adjacent collagen network. a quality of life (QoL) questionnaire. Table 1Expansion of the initial lymphatics A patch test was also performedcauses the interstitial fluid to fill the to ensure the participants were Between subject reproducibility:open endothelial micro-valves through not allergic to the tape material or bio-impedance measurementspercolation, while compression causes adhesive. (Moseley and Piller, 2008)closure of the endothelial micro-valves and outflow along the lumen After surgery, participants were Position Covarianceof the micro-lymphatics, with eventual divided in two groups, a lymph taping (%)transport to collecting lymphatics. group and a current best practice Affected BreastReflux towards the initial lymphatics is group 8 Upper outer quadrant (R0a) 0.34%prevented by bicuspid valves. 8 Upper inner quadrant (R0) 0.24% Starting on day one postoperatively, 8 Lower outer quadrant (R0) 0.24%Bio-impedance lymph taping was applied every five 8 Lower inner quadrant (R0) 0.53%A promising technique in measuring days to the lymph taping group. The 8 Upper outer quadrant (Rfb) 0.40%breast changes is bio-impedance. tape was cut into three strips and 8 Upper inner quadrant (Rf) 0.48%Local bio-impedance uses electrical applied over the watershed between 8 Lower outer quadrant (Rf) 0.86%currents to measure the impedance the posterior thoracic skin territories 8 Lower inner quadrant (Rf) 0.54%of the tissue and, therefore, the fluid and from spine to axilla (Figure 1).volume. This type of technique has The patient was positioned so that Normal Breastbeen previously used to measure the skin was slightly stretched before 8 Upper outer quadrant (R0) 0.20%arm lymphoedema (Cornish et al, the application of the tape. Once the 8 Upper inner quadrant (R0) 0.36%2001; Box et al, 2002), breast fluid skin returned to its normal position, it 8 Lower outer quadrant (R0) 0.48%volume (Mosely and Piller, 2008), was drawn up to create an underlying 8 Lower inner quadrant (R0) 0.33%and breast tumours (Ohmine et al, negative pressure (Williams, 2006). 8 Upper outer quadrant (Rf) 0.38%2000). As demonstrated in Table 1, 8 Upper inner quadrant (Rf) 0.45%the covariance for bio-impedance The participants were encouraged 8 Lower outer quadrant (Rf) 0.39%measurements is quite low, ranging to perform early arm motion, including 8 Lower inner quadrant (Rf) 0.32%from 0.20–0.86%, demonstrating that abduction of the arm at 90° and a R0 represents the extracellular fluidthe between subject reproducibility arm raising. Participants were also measurementis consistent and therefore reliable encouraged to resume their normal b Rf represents both the intra and(Mosely and Piller, 2008). daily activities (Gonzalez et al, 2003). extracellular measurement General advice was provided toRationale participants regarding skincare, e.g.This study was undertaken to how to wash and dry the skin, to avoiddetermine the effect of lymph taping using warm air to dry the tape and toon post-operative seroma following seek advice if problems occurred.breast cancer surgery. Most of theliterature is based on the effect of In both the current best practicelymph taping in oedema of the arm. group and the lymph taping group,However, the use of lymph taping for seroma aspirations were taken usingseroma management does not appear techniques currently approved by theto be considered, even though there Department of Surgery, at Flindersare similarities in the nature of the University and Medical Centre.fluid accumulation. Parameters collected from the Figure 1. Lymph taping over the watershed betweenMethod sample groups included age, body the posterior thoracic skin territories from theEthical approval was obtained from mass index (BMI), type of surgery spine to axilla. ?? Journal of Lymphoedema, 2010, Vol 5, No 2
Clinical RESEARCH/AUDIT Outer edge of breast Table 2 Half way point Characteristics of the participants Subject Age (years) Weight Height (cms) BMI * (kgs) Nipple Mean 57.5 66.8 162 25.5 Standard Deviation 13.0 11.5 5.8 4.1Figure 2. Breast quadrants and halfway point. * Body Mass Index calculated as weight (kgs) / height (m2) Allocation to either the treatmentgroup or the current best practice their volume index and work out participants with a tumour diametergroup was performed by the toss of a the actual volume (ECF volume = less than 25mm and in three of thecoin for the first patient — subsequent pECF*L^2/R0). A P value of <0.05 five with a tumour diameter greaterparticipants were then allocated to was considered significant. than 25mm.each group alternately. Results There were two grade I tumoursLocal bio-impedance Nine women who had treatment (25%), three grade II (37.5%), and twoThe fluid impedance of each breast for their breast cancer entered the grade III (25%). In one patient therequadrant was measured using the study but one was excluded due to a were no tumour grade details listed.Impedimed® Imp SFB7 bio-impedance prolonged surgical intervention. The There were two seromas requiringunit (Impedimed). The electrodes mean age of the women was 57.5 aspiration in the grade II tumour groupwere placed in a straight line along the years with a range of 41–79 years. and one in the grade III tumour group.halfway point of the breast (Figure 2) Four participants had undergone MRM,and a multi-frequency current (5-500Hz) while the other four had undergone The model number of lymph nodeswas applied through the electrodes WLE. Six were also treated with removed was 10 ± 6 (range 1–15).to measure the fluid impedance. ALND, while a further two underwent Four participants (50%) had positiveThe measurement data was then a SLNB. Table 2 displays the group lymph nodes, while three of the fourdownloaded and stored in a laptop. demographic and anthropometric developed seromas that needed characteristics. aspiration.AnalysisAll data was analysed using SPSS®. Closed suction drainage was used The bio-impedance figure (seeAll results are expressed as means ± in all participants and the carcinoma Analysis section above for explanation)standard deviation in tables. Paired was invasive in all of the participants. representing the mean volume oft-tests were used to compare the Four participants developed seromas extracellular fluid (ECF) at t0 wasextracellular fluid (ECF) volume and that required aspiration — three of 0.0868 ± 0.0106 and 0.0858 ± 0.0182QoL with and without lymph taping. these had undergone MRM and one for lymph taping and current bestThe ECF volume was determined had undergone WLE. All were treated practice groups respectively. At oneusing the formula: with ALND. day postoperatively the mean volume of ECF was 0.1224 ± 0.0279 (a 41%ECF volume index = L^2/R0 Two of the four participants who increase) and 0.1118 ± 0.0083 (a(where ‘L’ is the length and R0 is the developed seromas were treated 30% increase) respectively for thevalue measured by the bio-impedance with lymph taping, while the other lymph taping and current best practicedevice) two received current best practice, groups. Taping was commenced after including general skin and limb this first postoperative measure. Because the resistivities for care advice and a gentle exerciseextracellular fluid (ECF), intracellular programme. The mean amount of The mean volume of ECF onfluid (ICF) and total body fluid (TBF) aspirate was 175.82 ± 109.29ml day five was 0.1189 ± 0.0308 (2.9%are not known, the authors could not (range 20–335ml). The number of decrease) and 0.1165 ± 0.0181 (4.3%draw interferences about the relative aspirations ranged from 2–5. increase) respectively for the lymphamounts. Nevertheless, it was possible taping and current best practiceto draw conclusions from the trend The mean tumour diameter of groups.in each. If the resistivity of ECF in the all participants was 33.63±14.59mmbreast quadrants is ever measured in (range 13–50mm). Seromas required On day 9 this volume was 0.1302the future, the authors could multiply aspiration in one of the three ± 0.2922 (6.4% increase) and 0.1190 Journal of Lymphoedema, 2010, Vol 5, No 2 ??
Clinical RESEARCH/AUDIT current best practice results in an Table 3 increase in volume of ECF. Extracellular fluid Quality of life was scored on seven variables (Table 4). Between t1 and t5 there was a substantial difference Randomisation ECF t0 ECF t1 ECF t5 ECF t9 ECF t16 between the lymph taping group by treatment and current best practice group, but Current best Mean 0.0858 0.1118 0.1165 0.1190 0.1066 after t5 the variables showed large practice total SD 0.0182 0.0083 0.0181 0.2059 0.0227 improvements as shown in Figures 3–5. group n=4 Percentage 30% +4.27% +6.48% –4.59% Lymph taping Mean 0.0868 0.1224 0.1189 0.1302 0.1037 The subjects’ range of motion total group n=4 SD 0.0106 0.0279 0.0308 0.2922 0.0324 (ROM) improved during t1 and t16 in Percentage +41% –2.86% +6.36% –15.32% the lymph taping group. After 16 days of treatment, substantial improvements Current best Mean 0.0855 0.1138 0.1260 0.1259 0.1210 were found in burning sensations practice with SD 0.0235 0.0138 0.0106 0.0274 0.0228 (66.7%), tightness (50%) and heaviness aspirations n=2 Percentage +33.1% +10.7% +10.6% +6.3% (100%) in the lymph taping group. Lymph taping Mean 0.0859 0.1329 0.1409 0.1503 0.1301 However, the ‘ball-like’ feeling increased with aspirations SD 0.0157 0.0344 0.0278 0.0227 0.0145 by 150% in the current best practice n=2 Percentage +54.7% +6% +13.1% –2.1% group compared to 250% in the ECF volume index = L^2/R0 lymph taping group. There was a small increase in pain (11.1%) in the current best practice group. Table 4 Substantial differences were observed for the pain perception Quality of life (scored on 10-point visual analog scale [means shown] between the two groups at t0 (P = .08), t1 (P < .08) and t5 (P < .08). t0 t1 t5 t9 T16 However at t9 (P < .22) and t16 (P < .18) this difference was no longer QoL LT CBP LT CBP LT CBP LT CBP LT CBP substantial, meaning that the pain Pain 2.75 1.20 4.25 2.25 5.00 1.67 4.50 3.00 4.25 2.50 perception for the lymph taping group Heaviness 1.50 1.00 1.50 1.00 3.25 1.00 1.75 2.25 2.00 2.00 improved (Table 5). None of these values were statistically significantly Tightness 1.00 1.00 2.50 1.50 5.25 1.67 2.75 3.50 2.50 2.25 different, however, a larger study may Temperature 1.00 1.00 1.00 1.00 2.75 1.00 1.00 1.00 1.00 1.00 show them to be so. Burning 1.00 1.40 1.00 1.50 1.00 1.00 1.00 2.25 1.00 2.50 sensations Discussion Seroma is widely accepted as a Ball-like feeling 2.00 1.00 1.00 1.00 4.25 1.00 2.50 2.25 3.50 1.50 normal complication following breast ROM 2.75 1.00 5.00 3.50 4.00 2.83 2.50 2.88 1.88 1.75 cancer surgery. Gonzalez et al (2003) called it a ‘necessary evil’ that occurs unpredictably in a predictable number± 0.2059 (6.5 % increase) for lymph 3). By looking at the par ticipants of patients. The authors believe thattaping and current best practice requiring aspirations (two in each of this view of seroma should change.respectively. On day 16 the mean the current best practice and lymph Every aspiration may cause infectionvolume measurement of ECF was taping groups), the mean volume of and, therefore, a higher risk of0.1037 ± 0.0324 (15.3% decrease) ECF decreased more in the lymph lymphoedema. Seroma should notand 0.1066 ± 0.0227 (4.6% decrease) taping group. be looked upon as being a normalrespectively for the lymph taping and complication.current best practice groups. Table 3 shows a mean volume of 0.1301 ± 0.0145 (a 2.1% decrease) The incidence of lymphoedema These results suggest that and 0.1210 ± 0.0228 (a 6.3% increase) has been evaluated in manyboth the shor t term (five days respectively for the lymph taping studies. However, the incidence ofpostoperatively) and longer term (16 and current best practice groups on lymphoedema after the presence ofdays postoperatively) par ticipants day 16. Thus lymph taping results in a seroma has not yet been evaluated.benefit from lymph taping (Table a decrease in volume of ECF, while The authors suggest that more ?? Journal of Lymphoedema, 2010, Vol 5, No 2
Clinical RESEARCH/AUDITresearch needs to be conducted into ROMthe incidence of lymphoedema after Ball-likethe presence of a seroma. feeling Burning sensation QOL variables In this study, one patient had Current best practice Temperaturethyroid problems and developed Lymph tapinga seroma that needed aspiration. TightnessAlthough the patient was taking Heavinessmedication, thyroid problems maybe a predisposing factor for seroma Paindevelopment. Because of the -50 0 50 100 150 200 250 300 350presence of an oedematherapist Percentagespecialised in lymph taping at the Figure 3. Quality of life: percentage changes on day one post-op’ versus day five post-op’breast care unit, this patient wasreferred for treatment. In most ROMsettings this is not the case. Ball-like feeling A higher score of ‘ball-like feeling’ Burningwas reported in the lymph taping sensation QOL variables Current best practicegroup. This might be explained through Temperature Lymph tapinglymph taping pulling the fluids away Tightnessfrom one area and allowing themto accumulate in another (resulting Heavinessin the ‘ball-like feeling’). If this is the Paincase it could be seen as a positive -60 -30 0 30 60 90 120 150development, i.e. the fluid moving away Percentagefrom the affected area, but perhapsnot far enough. Figure 4. Quality of life: percentage changes on day one post-op’ versus day nine post-op’ The authors continue to seek ROMmethods that will decrease this ‘ball- Ball-like feelinglike feeling’ and suggestions include Burninga breathing programme (i.e. to set sensation QOL variables Current best practiceup a proximal pressure gradient Temperature Lymph tapingbetween this area and the drainage Tightnesspoints) or the placement of furtherlymph tape to stimulate drainage over Heavinessthe watershed to other lymphatic Painterritories. -100 -50 0 50 100 150 200 250 Before the study, it was Percentagehypothesised that lymph taping can Figure 5. Quality of life: percentage changes on day one post-op’ versus day 16 post-op’be a useful and harmless strategy forthe prevention or management of Table 5seroma after breast cancer surgery.This hypothesis was supported as Quality of life difference between groups (p values indicated)those participants who received lymphtaping had substantially less seroma onday 16 than those who received best QOL t0 QOL t1 QOL t5 QOL t9 QOL t16current practice. However, the authors Pain .080 .076 .072 .215 .180believe that studies with higher Heaviness .264 .317 .079 .741 1.000numbers of participants are requiredto demonstrate statistically significant Tightness 1.000 .508 .138 .549 1.000changes. Nevertheless, there is still Temperature 1.000 1.000 .186 1.000 1.000a degree of practical significance to Burning sensations .371 .127 1.000 .317 .317support this hypothesis. In this study,the authors demonstrated a decrease Ball-like feeling armpit .264 1.000 .186 .881 .225in mean volume of extracellular fluid in Journal of Lymphoedema, 2010, Vol 5, No 2 ??
Clinical RESEARCH/AUDITthe breast. Concurrently, the subjects Cornish BH, Chapman M, Hirst C,QoL improved on several variables, Mirolo B, Bunce IH, Ward LC, Thomas BJ (2001) Early diagnosis of lymphedemaincluding ROM, burning sensations,tightness and heaviness. using multiple frequency bio-impedance. Key points Lymphology 34(1): 2–11 These results suggest that the Gardner A, Pass HA, Prance S (2005) 8 Frequent complications of Techniques in the prevention and breast cancer treatmentoutcome for participants can be management of breast seroma: Animproved using this relatively easy evaluation of current practice. Women’s include bleeding, infection,approach. Oncology Rev 5(3): 135–43 lymphoedema (arm and breast) and nerve damage, but Cancer Society of New Zealand (2003)Conclusion Post-Operative Problems after Breast Cancer the most common is seromaThe optimal way to manage a seroma Surgery. Cancer Society – brief facts. formation.is unknown. Most clinicians will aspirate Available at: http://22.214.171.124/csw- latest/html/index.php?url=/csw-latest/html/ 8 Lymph taping has the potentiala symptomatic seroma and thereafter patient/cs_patient_01_facts.php (accessedonly re-aspirate if the seroma re- to reduce seroma formation 27 August, 2010)appears. Usually this is indicated by but currently its potentialthe patient or the breast nurse (on Dawson I, Stam L, Heslinga JM, benefits in this context have Kalsbeck HL (1989) Effect of shoulder not been fully investigated.re-examination). In our opinion, the immobilization on wound seroma andrisk of additional inflammation and shoulder dysfunction following modified 8 This study used bio-impedanceassociated increased oedema is not radical mastectomy: a randomized prospective clinical trial. Br J Surg 76: spectroscopy of the breast,acceptable with this invasive technique. 311–12 on the side of the surgery, toThis pilot study has demonstrated Gonzalez EA, Saltzstein EC, Riedner CS, assess intra and extracellularthat Lymph Taping has the potential Nelson BK (2003) Seroma formation fluid levels in each of the fourto become a non invasive method following breast cancer surgery. Breast J quadrants of the breast. Ato manage seroma. However, further 9(5): 385–8 questionnaire measuring qualitycontrolled trials need to be conducted Hashemi E, Kaviani A, Najafi M, Ebrahimi of life was administered.to confirm this. JL M, Hooshmand H, Montazeri A (2004) Seroma formation after surgery for breast 8 The study also used aAcknowledgement cancer. World J Surg Oncol 2: 44 questionnaire to measureThe CureTape® used in this study Kase K, Wallis J, Kase T (2003) Clinical quality of life.was funded by FysioTape B.V. the Therapeutic Applications of the KinesioNetherlands. Taping Method. 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