Background. Lymphedema secondary to breast cancer treatment is a common and serious problem for disease survivors. The objective of the current study was to identify the risk factors of secondary lymphedema after breast carcinoma treatment. Materials & Methods. The breast cancer patients who were followed up in three centers in Tehran and Mashhad in 2010 were recruited in the study. The circumference measurement was used for defining lymphedema. Results. Among 410 breast cancer patients, 123 cases (30%) developed lymphedema. Variables such as low educational level, body mass index (BMI), higher stage of disease, number of involved lymph nodes, comorbid diseases, trauma, infection, and the time after surgery showed significant correlation with the development of lymphedema. In logistic regression analysis, increase of 1？kg/m2 in BMI (OR？=？1.09; 95%？？CI 1.05–1.15), each number increase in lymph node involvement (OR？=？1.15; 95%？？CI 1.08–1.21) and the increase of every 1 month after surgery (OR？=？1.01; 95%？？CI 1.01–1.02) significantly increased the risk of lymphedema. Conclusion. The results of this study demonstrated that preserving a fitted BMI, emphasis on self-care, and educating preventive activities may have important roles in decreasing the lymphedema incidence and improving the patients’ quality of life. 1. Introduction Lymphedema (LE) is an external (or internal) manifestation of lymphatic system insufficiency and impaired lymph transport [1]. It is characterized by accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in extremities. The development of LE occurs when the lymphatic load exceeds the transport capacity. There are two general classifications of LE: primary and secondary. Primary LE develops as a consequence of a pathologic congenital and/or hereditary etiology. Secondary LE, which is more common, is caused by mechanical insufficiency of the lymphatic system due to surgery, radiation, chemotherapy, trauma, infection, tumoral blockage, chronic venous insufficiency, immobility, or tourniquet effects [2]. Upper extremity LE is one of the most common complications after breast cancer surgery with a reported incidence of 6% to 30% [3]. It is estimated that 120,000–600,000 patients suffer from postmastectomy lymphedema in the United States [4]. In a meta-analysis of 72 studies achieved by Disipio et al. in 2013, pooled estimate of lymphedema incidence was 16.6% (95% CI 13.6–20.2). It was 21.4% (14.9–29.8) when data were restricted to prospective cohort studies (30 studies) [5]. The occurrence time of
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