Patients in the intervention group also received standardised
manual lymph drainage. Firstly, lymph nodes of neck and axilla
were emptied. Secondly, axilloaxillary anastomoses at the breast
and back and lymphatics at the lateral side of the shoulder
(Mascagni pathway) were stimulated. Thirdly, the arm and hand
were drained from proximal to distal. One session took half an
hour. Patients were scheduled to receive 40 sessions of manual
lymph drainage, with an increase in frequency from once a week
to three times a week, and then a decrease to once a week, to
create a gradual adaptation of the lymph system and not to end
too abruptly.