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Diagnosis of Axillary Web Syndrome in Patients After Breast Cancer Surgery

Epidemiology, Risk Factors, and Clinical Aspects

A Prospective Study

Figueira, Patricia V.G., MPT; Haddad, Cinira A.S., DPT; de Almeida Rizzi, Samantha K.L., MPT; Facina, Gil, PhD; Nazario, Afonso C.P., PhD

American Journal of Clinical Oncology: October 2018 - Volume 41 - Issue 10 - p 992–996
doi: 10.1097/COC.0000000000000411
Original Articles: Breast

Objectives: Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors.

Methods: A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery.

Results: The majority of the cords appeared by the seventh day (66.1%), and the total incidence of the cords was 90.9% at the 180th day. The axilla was the place for 80% of the occurrence of AWS, and >70% of the cords were palpable. Flexion and abduction of the shoulder showed reduced range of motion. Pain was present in 39.7% of the patients. Lymphadenectomy as well as hypertension were associated with increased risk of cord development; diabetes was associated with a decreased risk.

Conclusions: The evaluation protocol applied here showed a high incidence of AWS, with palpable cords more frequent than visible ones. The significance of hypertension and diabetes mellitus as risk factors for cord development in AWS should be evaluated in future studies. The evaluation protocol developed in this study seems to be of great importance for early detection of AWS and could also be valuable for future treatment planning.

Breast Diseases Division of Universidade Federal de São Paulo, Sao Paulo, Brazil

Informed consent was obtained from all individual participants included in the study.

The authors declare no conflicts of interest.

Reprints: Patricia V.G. Figueira, MPT, 1088 Guiratinga st apt 101, Chácara Inglesa, Sao Paulo CEP 04141-001, Brazil. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.