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Is it contraindicated to acupuncture a patient after a recent mastectomy?

A: There is no absolute contraindication to acupuncture after a mastectomy. The advice we give to members in the Guide to Safe Practice, an internal document which contextualises the provisions of the Code of Safe Practice, is:

Most patients who have had lymph nodes removed (eg from the axilla after a radical mastectomy) are cautioned against being needled in the limb below the site of lymph node removal due to the increased risk of infection.

It is advisable to mark your treatment notes clearly and visibly to ensure that you do not overlook this in practice.

There have been some discussions about whether the entire quadrant of the body relating to the affected limb should be avoided. Most patients are, however, just advised by their consultants only to avoid having the affected limb needled.

We recommend that in each individual case you follow the individual guidelines the patient has been given by their consultant.

We would leave it to someone's professional judgement about when it would be appropriate to needle proximate to the scar tissue itself, but members are trained to err on the side of caution. Indeed, the nature of traditional acupuncture, where points can be used to act on areas of the body far removed from the needle site means that there are always ways of treating an affected area without going near it.

This is particularly apposite when the mastectomy has been accompanied by the stripping of lymph nodes in the axilla, after which many women experience some lymphoedema. Amplifying the advice we give in the Guide in a response to another enquirer, we said

As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.

Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area

and has shown that treating constitutionally without needling an affected limb can be very beneficial.

We have heard of instances where the prohibition of acupuncture after mastectomy has been total, and we can only re-iterate what we said in this response, there is no evidence that acupuncture has elsewhere on the body has any adverse effects on a post-mastectomy patient.

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