Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Dec 20:11:13-19.
doi: 10.2147/BCTT.S146635. eCollection 2019.

Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies

L A Koehler  1   2   3 , T C Haddad  4 , D W Hunter  5 , T M Tuttle  3   6
Affiliations
Review

Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies

L A Koehler et al. Breast Cancer (Dove Med Press). .

Abstract

Axillary web syndrome (AWS) is a common condition occurring in up to 86% of patients following breast cancer surgery with ipsilateral lymphadenectomy of one or more nodes. AWS presents as a single cord or multiple thin cords in the subcutaneous tissues of the ipsilateral axilla. The cords may extend variable distances "down" the ipsilateral arm and/or chest wall. The cords frequently result in painful shoulder abduction and limited shoulder range of motion. AWS most frequently becomes symptomatic between 2 and 8 weeks postoperatively but can also develop and recur months to years after surgery. Education about and increased awareness of AWS should be promoted for patients and caregivers. Assessments for AWS should be performed on a regular basis following breast cancer surgery especially if there has been associated lymphadenectomy. Physical therapy, which consists of manual therapy, exercise, education, and other rehabilitation modalities to improve range of motion and decrease pain, is recommended in the treatment of AWS.

Keywords: Mondor’s disease; axillary lymphadenectomy; cording; rehabilitation.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Axillary web syndrome of the left axilla. Note: Multiple cords are visible in the mid axilla.
Figure 2
Figure 2
Axillary web syndrome of the right extremity. Note: Multiple cords are visible in the axilla and medial upper extremity with extension into the antecubital fossa.
Figure 3
Figure 3
(A) In order to make an accurate diagnosis of the presence or absence of AWS. The physical examination should be performed in a manner that is designed to facilitate the search for the problem. The first step is to gently but maximally extend the arm at the elbow and then gently but maximally abduct the affected arm at the shoulder. The person performing the evaluation both visualizes and palpates for cords in the locations indicated in (B). (B) This figure illustrates the locations (see black lines) in which a cord or cords may be found, including the axilla, down the upper arm from the axilla to and across the antecubital space, and rarely down the forearm to the base of the thumb. Abbreviation: AWS, axillary web syndrome.
See this image and copyright information in PMC

References

    1. Koehler LA, Blaes AH, Haddad TC, Hunter DW, Hirsch AT, Ludewig PM. Research report movement, function, pain, and postoperative edema in axillary web syndrome. Phys Ther. 2015;95(10):1345–1353. - PMC - PubMed
    1. Koehler LA, Hunter DW, Blaes AH, Haddad TC. Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: an 18-month follow-up. Phys Ther. 2018;98(6):518–527. - PMC - PubMed
    1. Moskovitz AH, Anderson BO, Yeung RS, Byrd DR, Lawton TJ, Moe RE. Axillary web syndrome after axillary dissection. Am J Surg. 2001;181(5):434–439. - PubMed
    1. Leidenius M, Leppänen E, Krogerus L, von Smitten K. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg. 2003;185(2):127–130. - PubMed
    1. Koehler LA, Hunter DW. Lymphspiration: the axillary web and its lymphatic origin. Lymphology. 2016;49(4):185–191. - PubMed