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pandora charms Detection and treatment of breast cancer have significantly improved over past decades, which results in higher survival rates.1 More attention is now therefore paid to complications related to treatment, such as arm lymphoedema.For a woman with breast cancer, lymphoedema is a debilitating and incurable problem that is caused by reduced transport capacity of the lymph system (related to the surgery or radiotherapy, or both), sometimes combined with an increase in lymph load (related to hypertension, for example).2 3 Twelve months after axillary lymph node dissection, the point prevalence of arm lymphoedema ranges from 12%4 to 26%,5 though some have reported point prevalence rates up to 70%.6 This wide variety is related to differences in treatment of breast cancer, methods of measurement, delay in measuring, and definition of lymphoedema.7 Use of the most accurate and reliable method for assessment is crucial to advance our understanding of preventive strategies.8 To register the natural difference between the dominant and non dominant arm pandora jewelry, volume and circumferences of both arms have to be assessed before axillary lymph node dissection.9 Commonly used definitions for arm lymphoedema, taking into account preoperative differences, are a change of 200 mL or more in volume10 or a change in circumference of 2 cm or more at two adjacent measurement sites,11 both compared with the preoperative value, together with a subjective feeling of swelling.9 Around 67 80% of patients with lymphoedema develop arm swelling within the first year after axillary lymph node dissection.12 13 Possible risk factors are being overweight, radiotherapy (of the axilla or supraclavicular region, or both), and the number and levels of axillary lymph nodes dissected.14 15 16Prevention of lymphoedema after axillary dissection for breast cancer is poorly investigated. Recently, one study showed that a combination of guidelines, exercise therapy, and manual lymph drainage was more effective in preventing arm lymphoedema than just guidelines.11 In another study, fewer patients who received guidelines and exercise therapy after axillary dissection developed lymphoedema than patients without treatment, although this difference was not significant.10 As far as we are aware, the preventive effect of manual lymph drainage on the development of lymphoedema has not been investigated in a randomised controlled trial.17 Manual lymph drainage is an integral part of lymphoedema treatment. It is a gentle massage technique and has different purposes: stimulating resorption of lymph by the lymph capillaries, increasing lymph transport from the hand to axilla by existing lymph collaterals, and creating lymph collateral pathways between the arm and trunk and between both axillas (that is, the Mascagni pathway and axilloaxillary anastomoses).18 19We compared the effect of a treatment programme consisting of guidelines, exercise therapy, and manual lymph drainage (intervention group) and the same programme without lymph drainage (control group) on the development of lymphoedema related to breast cancer.MethodsParticipantsBetween October 2007 and February 2009, all patients with operable breast cancer and scheduled for unilateral surgery at the multidisciplinary breast centre of the University Hospitals in Leuven were assessed before surgery pandora charms.