Minimizing shoulder swelling, called lymphedema, caused by breast cancer treatment is a key goal for both patients and physicians because of its detrimental impact on physical, psychological, and social well-being. Historically, radiotherapy to the axillary breast nodes in the 1970s and 1980s was associated with major patient harm. This led to lymphedema and nerve damage, known as brachial plexopathy, causing severe pain and loss of function in the arm. The causes of these problems were multifactorial. They included high radiation doses, overlapping radiotherapy fields and poor quality radiotherapy without standardized protocols and quality assurance. The article is a commentary on hypofractionated nodal radiotherapy in breast cancer and asks whether it is time for an updated standard of care.