The Role of Axillary Reverse Mapping in Reducing Lymphedema in Patients with Early Breast Cancer: A Prospective Randomized Study

Introduction: Breast cancer–related lymphedema (BCRL) is a frequent and debilitating complication of axillarylymph node dissection (ALND). Axillary reverse mapping (ARM) aims to identify and preserve lymphatic drainagepathways of the upper limb to reduce postoperative lymphedema risk.Aim of work: To evaluate ARM feasibility, detection rate, and its efficacy in preventing lymphedema in earlybreast cancer.Pathients and methods: In this prospective randomized study, 80 women with early-stage breast cancer (T1–T2, non-palpable axillary nodes) were randomized to ARM + ALND (n = 40) or standard ALND (n = 40). ARMinvolved subdermal injection of 3 mL methylene or patent blue into the upper arm, with preservation of bluestainedlymphatics unless oncologically suspicious. Arm circumference was measured preoperatively and at 6, 12,and 18 months post-operatively. Lymphedema was defined as ≥ 2 cm inter-arm difference at any anatomical site.Results: ARM identified blue-stained lymph nodes in 100% of cases (1–3 nodes per patient). Lymphedemaincidence was significantly lower in the ARM group at 6 months (0% vs. 15%, p = 0.042), 12 months (5% vs.45%, p = 0.035), and 18 months (10% vs. 55%, p = 0.023). Mean arm circumference was significantly smaller inthe ARM group at all postoperative time points (p < 0.05).Conclusion: ARM is a feasible and effective technique for reducing postoperative lymphedema in early breastcancer patients undergoing ALND, without compromising oncological safety. Incorporating ARM into surgicalpractice may improve postoperative quality of life.