Arm morbidity in 131 women with small breast tumours (up to 10 mm) who all had level 2 axillary clearance

We report the arm morbidity in 131 patients with small breast cancers up to IO mm in size and who had an identical level 2 axillary clearance between 12 and 132 months previously. 19 patients (15%) were node positive. None had radiotherapy to the axilla. 71 had non palpable tumours which were localised preoperatively. 23 had a mastectomy and 108 had breast conserving surgery. 83 had radiotherapy to the breast. Sequential circumferential measurements were made and arm volumes calculated on both the operated and the normal side. Shoulder movements were measured and subjective symptoms recorded by questionnaire. 9 (7%) women had objective swelling of the arm. 24 (18%) had some restricted arm movement. There was no association between objective morbidity and possible causative factors including time since surgery, the operating surgeon, the handedness of the patient, smoking, number of nodes removed or involved, age, body mass index. Although objective morbidity is low, most women reported feeling swelling, stiffness, discomfort or numbness. 30 patients said symptoms restricted norrnal activity in some way. There was no association between objective and subjective swelling and joint mobility. The morbidity in this study is more likely to be due to surgery rather than axillary disease. Objective morbidity is low but subjective symptoms require further study.