Dear Editor-in-Chief,
Please find enclosed the revision of our paper entitled “Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review”.
We thank the reviewer and the editor-in-chief for the valuable comments that have contributed to a significant improvement of our manuscript. Please, find enclosed a point-to-point response to the remarks given by the reviewer and editor at the end of this cover letter. We also enclose a copy of the revised manuscript.
We hope that the revised version of the manuscript is now suitable for publication in Breast Cancer Research and Treatment.
The corresponding author is Nick Gebruers. Please, address correspondence to: Nick Gebruers, PT PhD, Department of Rehabilitation Science and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium (e-mail: )
On behalf of all authors,
yours sincerely,
Hanne Verbelen, PT
University of Antwerp
Faculty of Medicine and Health Sciences
Department of Rehabilitation Sciences and Physiotherapy
Point-to-point response to the Reviewers' comments:
Remark: I might ask that they make a stronger case as at the beginning as to why this is an important topic. They do make some statement about impact on cosmesis/quality of life, and increasing in cup size, but this might be expanded. How did this problem affect the quality of life? This could be elaborated.
Reply: Thank you for this comment. We have incorporated your suggestions in the introduction.
Despite the benefits of BCS, breast edema can be uncomfortable and is associated with distress[12]. The breast asymmetries due to swelling of the breast may cause an unsatisfactory cosmetic result and patients with breast edema mention changes in clothing habits[9,13]. Because of the significant symbolism of the breast, breast edema can influence the body image which has a definite impact on quality of life (QoL)[2,5]. Especially younger patients have reported changes in body image[13]. Because of the evolution in the treatment of breast cancer, the survival rate has increased significantly over years. As a result, the long term health problems, including QoL, related to breast cancer and its treatment are becoming more important.
Remark: The second issue that I would like the authors to do is to add a paragraph or two on the treatment of breast edema. It is interesting to read about breast edema, know the incidence rates etc.., but if it is there, what do we do about it. Since this is a review, the authors could also include the different ways of treatment as described in the literature and whether they are successful or not.
Reply: Thank you for your comment. The treatment of breast edema was not incorporated in the systematic search strategy. We did search the literature on the treatment of breast edema, but it is little described. However, we tried to expand on this matter in the discussion.
Although breast edema is common, its treatment is little described in the literature. Mostly its treatment is based upon the knowledge of the treatment of lymphedema of the upper limb. Lymphedema is commonly treated by complex physical therapy (CPT) comprising manual lymphatic drainage, compression therapy, skin care and exercises[9,36]. Another treatment investigated by Jahr et al. is deep oscillation combined with manual lymphatic drainage on breast edema. Deep oscillation is a therapeutic approach that consists in applying an intermittent electrostatic field of low intensity and extremely low frequency to the target area. The study showed that additional deep oscillation supplementary to manual lymphatic drainage can significantly enhance pain relief and swelling of the breast[36]. Further studies are urgently needed to investigate the treatment of lymphedema of the breast.