Guidelines for Complications of Cancer Treatment Vol VIII Part B

had significant lymphoedema. The factors that increased therisk for lymphoedema were BMI more than 25% (p=0.007),surgery on the dominant side (p=0.045), and post-mastectomy(as compared to BCT) (p25% increasedlymphoedema 5.3 times (HR=5.38, 95% CI 1.5-18.2,p=0.007); at 20-25% BMI, risk increased by 3.4 times(HR=3.4, 95% CI 0.98-12.2, p=0.05).Axillary WebsAxillary webs are tight bands of scar tissue developing afteran axillary clearance in 10% cases. They appear like a cordlikestructure across the axilla, along the arm occasionallyreaching the thumb, and may sometimes even be painful. Buttheir main effect is a tightness and limitation of movement atthe shoulder. The treatment is to only observe and allow thisto resolve on its own. It mostly disappears without anysequelae.Post Breast Reconstruction DisastersBreast reconstruction using free flaps is commonly offeredfor multicentric disease and involves extensive surgery at thedonor site with sometimes skin grafting performed to coverthe defects. Free microvascular surgery carries the inherentrisk of vascular accidents with venous or arterial thrombosis.The consequences can be disastrous. Not only is there a failureof procedure but there is also major loss of tissue cover forthe primary site and the psychological stress for the patient isextreme. The donor site also carries a risk of hematoma,seroma, flap necrosis and hypertrophic scars. Breast implantsmay need to be removed early in the postoperative period incase of wound infection. Implants also carry a risk of ruptureor displacement.10