Secondary lymphedema of the arm (SLEA) is the most common consequence of operation and/or radiotherapy for the malignant tumors of the breast. The frequency of SLEA is from 6 to 30 percent in patients with breast cancer This paper presents literature data about the methods of physical treatment of SLEA. A complex of decongestive physical therapy (CDP) is described consisting of the skin care of the arm on the operated and/or irradiated side, kinesy therapy, manual lymphodrainage of arm, and ban- daging with multilayer non elastic bandages of the arm. Along with CDP, a device assisted sequential pneumatic compression can be applied in order to reduce the SLEA. The prevention and early detection of SLEA, while it is still reversible, is the most important task in the postoperative and postirradiation period after the treatment of breast cancer.

A program of early postoperative rehabilitation (kinesy therapy and education) has been conducted since 1996 in our Department for Rehabilitation at the Institute of Oncology in Sremska Kamenica. The aim of this program is to prevent the appearance of secondary lymphedema of the arm and the contacture of the shoulder. Unless the patient, in further follow up, does not have any complication, a program of "late" rehabilitation is conducted. If secondary lymphedema of the arm (SLEA) is evolved, then the patient is submitted to a complex of decongestive physical therapy (CDP) or CDP and sequential pneumatic compression (SEPC). However if SLEA and local alterations on the skin exist, we immobilize the arm (mitela, plaster). In other cases without SLEA, e.g. periarthritis or the damage of brachial plexus, we perform physical procedures (kinesy therapy TENS, kryo-massage and acupuncture). With regard to the degree of complication of SLEA and consequences that might develop the starting point should be directed towards early detection of SLEA.