The injunction to avoid using a patient’s ipsilateral arm for phlebotomy and blood pressure dates back to the days when radical mastectomy was the norm, along with much more extensive axillary node dissection. This surgical approach was based on the theory that tumours grew locally to a certain size prior to metastasizing, and local control needed to be optimal. We’ve since learned that tumours will shed tumour cells at a very early stage, of which only some will ever cause clinical problems. This realization led to a number of studies, which demonstrated that success rates were often just as good with conservative surgery as with radical surgery.

Today, a large number of women opt to receive conservative surgery, and many even choose to have sentinel node biopsies rather than full axillary node dissection. The advice nearly always given to them is never to use that arm again for BP or phlebotomy. There’s no scientific evidence that doing so made a difference when radical mastectomies were done — it was simply the consensus of the day — and with modern surgical techniques I have no hesitation in allowing my patients to ignore this old rule.

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