Lymphedema secondary to breast cancer causes physical and psychological morbidity and compromises quality of life. The objective of this literature review was to study lymphatic compensation after surgery for breast cancer and the factors that influence this process, with a view to understanding the etiopathogenesis of lymphedema. Articles indexed on Pubmed published from 1985 to 2012 were reviewed. According to the literature, lymphangiogenesis reduces damage to lymph vessels; there is little evidence that Vascular Endothelial Growth Factor is elevated in women with lymphedema; lymphovenous communications can be observed 60 days after surgery; women without lymphedema have acquired alternative mechanisms for removal of proteins from the interstitial space; and active exercise stimulates lymphatic and venous pumping. Health professionals should teach these patients about the risk factors for lymphedema. The effects of lymphangiogenesis, proteolysis and lymphovenous communications on development of lymphedema should be studied, since these events are intimately related. © 2015, Sociedade Brasileira de Angiologia e Cirurgia Vascular. All rights reserved.142161167Preston, N.J., Seers, K., Mortimer, P.S., Physical therapies for reducing and controlling lymphoedema of the limbs (2009) Cochrane Database Syst Rev, (1)Petrek, J.A., Senie, R.T., Peters, M., Rosen, P.P., Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis (2001) Cancer, 92 (6), pp. 1368-1377. , http://dx.doi.org/10.1002/1097-0142(20010915)92:6<1368::AID-CNCR1459>3.0.CO;2-9, PMid:11745212Clark, B., Sitzia, J., Harlow, W., Incidence and risk of arm oedema following treatment for breast cancer: A three-year follow-up study (2005) QJM, 98 (5), pp. 343-348. , http://dx.doi.org/10.1093/qjmed/hci053, PMid:15820971Stanton, A., Modi, S., Mellor, R.H., A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphoedema following breast cancer treatment (2006) Clin Sci, 110 (5), pp. 553-561. , http://dx.doi.org/10.1042/CS20050277, PMid:16343054Kim, C., Li, B., Papaiconomou, C., Zakharov, A., Johnston, M., Functional impact of lymphangiogenesis on fluid transport after lymph node excision (2003) Lymphology, 36 (3), pp. 111-119. , PMid:14552030Bates, D.O., An interstitial hypothesis for breast cancer related lymphoedema (2010) Pathophysiology, 17 (4), pp. 289-294. , http://dx.doi.org/10.1016/j.pathophys.2009.10.006, PMid:19963358Tsai, R.J., Dennis, L.K., Lynch, C.F., Snetselaar, L.G., Zamba, G., Scott-Conner, C., The risk of developing arm lymphedema among breast cancer survivors: A meta-analysis of treatment factors (2009) Ann Surg Oncol, 16 (7), pp. 1959-1972. , http://dx.doi.org/10.1245/s10434-009-0452-2, PMid:19365624Warren, A.G., Brorson, H., Borud, L.J., Slavin, S.A., Lymphedema: A comprehensive review (2007) Ann Plast Surg, 59 (4), pp. 464-472. , http://dx.doi.org/10.1097/01.sap.0000257149.42922.7e, PMid:17901744Hayes, S.C., Janda, M., Cornish, B., Battistutta, D., Newman, B., Lymphedema after breast cancer: Incidence, risk factors, and effect on upper body function (2008) J Clin Oncol, 26 (21), pp. 3536-3542. , http://dx.doi.org/10.1200/JCO.2007.14.4899, PMid:18640935Bicego, D., Brown, K., Ruddick, M., Storey, D., Wong, C., Harris, S.R., Exercise for women with or at risk for breast cancer-related lymphedema (2006) Phys Ther, 86 (10), pp. 1398-1405. , http://dx.doi.org/10.2522/ptj.20050328, PMid:17012644Francis, W.P., Abghari, P., Du, W., Rymal, C., Suna, M., Kosir, M.A., Improving surgical outcomes: Standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection (2006) Am J Surg, 192 (5), pp. 636-639. , http://dx.doi.org/10.1016/j.amjsurg.2006.08.018, PMid:17071198Lane, K., Worsley, D., McKenzie, D., Exercise and the lymphatic system: Implications for breast-cancer survivors (2005) Sport Med, 35 (6), pp. 461-471Stanton, A.W., Modi, S., Bennett Britton, T.M., Lymphatic drainage in the muscle and subcutis of the arm after breast cancer treatment (2009) Breast Cancer Res Treat, 117 (3), pp. 549-557. , http://dx.doi.org/10.1007/s10549-008-0259-z, PMid:19052859Rezende, L.F., Pedras, F.V., Ramos, C.D., Gurgel, M., Evaluation of lymphatic compensation by lymphoscintigraphy in the postoperative period of breast cancer surgery with axillary dissection (2011) Tumori, 97 (3), pp. 309-315. , PMid:21789008Modi, S., Stanton, A., Mortimer, P.S., Levick, J.R., Clinical assessment of human lymph flow using removal rate constants of interstitial macromolecules: A critical review of lymphoscintigraphy (2007) Lymphat Res Biol, 5 (3), pp. 183-202. , http://dx.doi.org/10.1089/lrb.2007.5306, PMid:18035937Pain, S.J., Barber, R.W., Solanki, C.K., Short-term effects of axillary lymph node clearance surgery on lymphatic physiology of the arm in breast cancer (2005) J Appl Physiol, 99 (6), pp. 2345-2351. , http://dx.doi.org/10.1152/japplphysiol.00372.2005, PMid:16288099Jila, A., Kim, H., Nguyen, V., Lymphangiogenesis following obstruction of large postnodal lymphatics in sheep (2007) Microvasc Res, 73 (3), pp. 214-223. , http://dx.doi.org/10.1016/j.mvr.2006.11.003, PMid:17188720Hutzschenreuter, P., Brümmer, H., Ebberfeld, K., Experimental and clinical studies of the mechanism of effect of manual lymph drainage therapy (1989) Z Lymphol, 13 (1), pp. 62-64. , PMid:2672666Leduc, O., Bourgeois, A., Bandages: Scintigraphic demonstration of its efficacy on colloidal protein reabsorption during muscle activity (1989) International Congress of Lymphology, pp. 421-423. , Amsterdam: ElsevierLane, K.N., Dolan, L.B., Worsley, D., McKenzie, D.C., Upper extremity lymphatic function at rest and during exercise in breast cancer survivors with and without lymphedema compared with healthy controls (2007) J Appl Physiol, 103 (3), pp. 917-925. , http://dx.doi.org/10.1152/japplphysiol.00077.2007, PMid:17585046Stanton, A.W., Holroyd, B., Mortimer, P.S., Levick, J.R., Comparison of microvascular filtration in human arms with and without postmastectomy oedema (1999) Exp Physiol, 84 (2), pp. 405-419Box, R.C., Reul-Hirche, H.M., Bullock-Saxton, J.E., Furnival, C.M., Physiotherapy after breast cancer surgery: Results of a randomised controlled study to minimise lymphoedema (2002) Breast Cancer Res Treat, 75 (1), pp. 51-64Yoon, Y.S., Murayama, T., Gravereaux, E., VEGF-C gene therapy augments postnatal lymphangiogenesis and ameliorates secondary lymphedema (2003) J Clin Invest, 111 (5), pp. 717-725. , http://dx.doi.org/10.1172/JCI15830, PMid:12618526Ahmed, R.L., Thomas, W., Yee, D., Schmitz, K.H., Randomized controlled trial of weight training and lymphedema in breast cancer survivors (2006) J Clin Oncol, 24 (18), pp. 2765-2772Sagen, A., Kåresen, R., Risberg MA. Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up (2009) Acta Oncol, 48 (8), pp. 1102-1110. , http://dx.doi.org/10.3109/02841860903061683Sarri, A.J., Moriguchi, S.M., Dias, R., Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment (2010) Exp Ther Med, 1, pp. 147-152Torres Lacomba, M., Yuste Sánchez, M.J., Zapico Goñi, A., Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: Randomised, single blinded, clinical trial (2010) BMJ, 340 (1), p. 5396. , http://dx.doi.org/10.1136/bmj.b5396, PMid:20068255Devoogdt, N., Christiaens, M.R., Geraerts, I., Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: Randomised controlled trial (2011) BMJ, 343, p. 5326Van Der Horst, C., Kenter, J., De Jong, M.T., Keeman, J.N., Shoulder function following early mobilization of the shoulder after mastectomy and axillary dissection (1985) Neth J Surg, 37 (4), pp. 105-108. , PMid:3900809De Rezende, L.F., Franco, R.L., De Rezende, M.F., Beletti, P.O., Morais, S.S., Gurgel, M.S., Two exercise schemes in postoperative breast cancer: Comparison of effects on shoulder movement and lymphatic disturbance (2006) Tumori, 92 (1), pp. 55-61. , PMid:16683384Oliveira, M., Gurgel, M., Miranda, M.S., Okubo, M.A., Feijó, L., Souza, G.A., Efficacy of shoulder exercise on locoregional complications in women undergoing radiotherapy for breast cancer: Clinical Trial (2009) Braz J Phys Ther, 13 (2), pp. 136-144. , http://dx.doi.org/10.1590/S1413-35552009005000017Williams, A.F., Vadgama, A., Franks, P.J., Mortimer, P.S., A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema (2002) Eur J Cancer Care (Engl), 11 (4), pp. 254-261. , http://dx.doi.org/10.1046/j.1365-2354.2002.00312.x, PMid:12492462Cheifetz, O., Haley, L., Breast Cancer Action. Management of secondary lymphedema related to breast cancer (2010) Can Fam Physician, 56 (12), pp. 1277-1284. , PMid:21375063Schmitz, K.H., Troxel, A.B., Cheville, A., Physical Activity and Lymphedema (The PAL trial): Assessing the safety of progressive strength training in breast cancer survivors (2009) Contemp Clin Trials, 30 (3), pp. 233-245. , http://dx.doi.org/10.1016/j.cct.2009.01.001, PMid:19171204Suami, H., Pan, W.R., Taylor, G.I., Changes in the lymph structure of the upper limb after axillary dissection: Radiographic and anatomical study in a human cadaver (2007) Plast Reconstr Surg, 120 (4), pp. 982-991. , http://dx.doi.org/10.1097/01.prs.0000277995.25009.3e, PMid:17805128Gomide, L.B., Matheus, J.P., Dos Candido Reis, F.J., Morbidity after breast cancer treatment and physiotherapeutic performance (2007) Int J Clin Pract, 61 (6), pp. 972-982. , http://dx.doi.org/10.1111/j.1742-1241.2006.01152.x, PMid:17362480Gashev, A.A., Zawieja, D.C., Physiology of human lymphatic contractility: A historical perspective (2001) Lymphology, 34 (3), pp. 124-134. , PMid:11549124Tartaglione, G., Pagan, M., Morese, R., Intradermal lymphoscintigraphy at rest and after exercise: A new technique for the functional assessment of the lymphatic system in patients with lymphoedema (2010) Nucl Med Commun, 31 (6), pp. 547-551. , PMid:20215978McGeown, J.G., McHale, N.G., Thornbury, K.D., The role of external compression and movement in lymph propulsion in the sheep hind limb (1987) J Physiol, 387 (1), pp. 83-93. , http://dx.doi.org/10.1113/jphysiol.1987.sp016564, PMid:3656186Bruyère, F., Noël, A., Lymphangiogenesis: In vitro and in vivo models (2010) FASEB J, 24 (1), pp. 8-21. , http://dx.doi.org/10.1096/fj.09-132852, PMid:19726757