ORIGINAL RESEARCH| Volume 102, ISSUE 8, P1465-1472.e2, August 2021

Treatment of Breast Cancer–Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial

Published:April 16, 2021DOI:



      To evaluate the efficacy of negative pressure massage treatment (NPMT) compared with manual lymphatic drainage (MLD) in women with chronic breast cancer–related lymphedema (LE). We hypothesized that NPMT would result in greater improvements in LE and upper limb function.


      Pilot single-blinded randomized controlled trial.


      Health sciences university.


      Of 64 women screened, 28 met eligibility requirements (ie, >18y of age; completed active treatment for breast cancer; had unilateral arm LE for ≥1y; were not receiving LE care; had stable LE) and were randomized to the NPMT (n=15) and control groups (n=13).


      The intervention group received NPMT and the control group received MLD; both received twelve 60-minute sessions over 4-6 weeks.

      Main Outcome Measures

      Bioimpedance (lymphedema index [L-Dex] units]), limb volume (mL) calculated from limb circumference, and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) score.


      Outcomes were analyzed for 28 women. Compared to the MLD group, the NPMT group demonstrated greater improvement with a large effect size in L-Dex scores (P=.001; standardized mean difference [SMD]=−1.15; 95% confidence interval, −1.96 to −0.35) and interlimb volume differences (P=.038; SMD=−0.83; 95% confidence interval, −1.60 to −0.05). Differences in DASH scores were not statistically significant (P=.067).


      Compared to MLD, treatment with NPMT resulted in greater improvement in L-Dex scores and interlimb volume differences in women with a duration of unilateral upper limb LE of >1 year. Our findings need to be confirmed in a larger randomized controlled trial.


      List of abbreviations:

      BC (breast cancer), BIS (bioelectrical impedance spectroscopy), DASH (Disabilities of the Arm, Shoulder, and Hand questionnaire), ECF (extracellular fluid), ES (effect size), L-Dex (lymphedema index), LE (lymphedema), MLD (manual lymphatic drainage), NPMT (negative pressure massage therapy), PI (principal investigator), RCT (randomized controlled trial), SMD (standardized mean difference)
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