The primary cause of postmastectomy edema is lymphatic obstruction, but venous obstruction can be a factor.
In 35 normal females, adduction phlebograms showed axillary vein positional obstruction with cephalic vein runoff in 34.3%. At 90° abduction the axillary system visualized normally.
In 14 postmastectomy edema patients, adduction phlebograms showed an abnormal axillary vein in 21.4%, and nonvisualization in 50%. At 90° abduction corresponding figures were 23.3% and 7.7%. The cephalic vein visualized whenever the axillary system did not.
In eight patients, axillary vein adhesions were lysed from the upper part of the arm to the thoracic inlet. Excellent results followed in four patients whose adduction phlebograms had shown axillary vein positional obstruction, and in one patient with localized stenosis.
Follow-up phlebograms on three patients showed, in adduction, restoration of the axillary vein runoff.
Larson NE, Crampton AR. A Surgical Procedure for Postmastectomy Edema. Arch Surg. 1973;106(4):475-481. doi:10.1001/archsurg.1973.01350160093015