Lymphadema

Lymphedema is the collection of protein-rich lymph fluid in the tissues of the hand, arm and/or chest wall on the side of the breast surgery. Lymphedema causes painless swelling of the hand, arm and/or chest. The condition occurs when the normal lymphatic drainage in the chest and arm are injured during surgery and/or radiation therapy.

Development and prevention

Most women who undergo breast surgery and radiation therapy do not develop lymphedema. However, it is important to learn and follow a few prevention strategies to reduce your risk of developing lymphedema.
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Lymphatic system

The lymphatic system is part of your immune system. It consists of a series of vessels which run along side your circulatory system (veins) and lymph nodes which are located around major organs and in certain tissue (under your arm for instance). The lymph system helps to filter out dead cells, protein and waste products in your veins. It also plays a role in mobilizing your immune system to fight off an infection.
During your breast surgery, the lymph vessels and nodes are usually cut and removed, especially if you had a sentinel or complete axillary lymph node dissection. This damages and disrupts the flow of lymphatic fluid in that region. Radiation therapy may cause further scarring. Most of the time, your body can adapt to these changes without excess fluid accumulating in the arm on the side of the breast surgery. However, lymphedema can occur from overusing that arm or from an infection, bug bite, cut or some other type of injury that causes excess fluid to build up that the body cannot remove. The buildup of lymphatic fluid causes swelling in the arm.
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Risk factors and occurrence

  • Women who have had breast surgery (either mastectomy or lumpectomy) with a complete axillary lymph node dissection have the highest risk of developing lymphedema.
  • Women who have only a sentinel lymph node procedure have a small risk of developing lymphedema.
  • Women who have not had a lymph node dissection do not develop lymphedema.
  • Lymphedema can be mild and only last a short time starting a few days after the lymph nodes are removed. The affected arm may be warm and slightly red, but usually not painful. It typically gets better within a week by keeping the arm elevated.
  • Lymphedema may not occur until six to eight weeks after surgery or during a course of radiation therapy.
  • Lymphedema can arise slowly and become noticeable 18-24 months after surgery or not until many years after finishing cancer treatment.
Some women will have very mild lymphedema that may fluctuate over time. However, most women with lymphedema will have chronic, constant swelling that requires regular management to prevent further problems. Physical therapists specially trained in lymphedema management techniques can help. They will teach you how to reduce swelling using a special type of self-massage, how to apply compression bandages, and how to wear a compression sleeve to maintain the arm’s size. Treatment to manage lymphedema is also available in some locations through a lymphedema clinic.
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Prevention

You can also take precautions to reduce the chance of developing lymphedema following breast surgery that includes a sentinel lymph node biopsy or a complete axillary lymph node dissection (with or without radiation therapy). The following are some suggestions to minimize your risk:

  • Do not carry heavy objects with your affected arm, including heavy handbags.
  • Avoid vigorous, repetitive motions with your affected arm that you are not used to doing. For example, clean only one or two windows at a time instead of all the windows in your house at the same time.
  • Keep the arm raised above the level of the heart, whenever possible.
  • Avoid needle sticks of any type in the affected arm.
  • Avoid blood pressure readings, blood draws, regular injections and intravenous injections in your affected arm to reduce the chance of trauma.
  • When taking a long plane flight (greater than two to three hours) wear a compression sleeve on your affected arm. You may also want to wear a sleeve when at high altitudes (greater than 5,000 feet) or while exercising.
  • Keep the skin on the affected arm and chest clean and well lubricated. Healthy intact skin is the best defense against infection. Use sunscreen with an SPF 30 or higher when outside.
  • Avoid tight clothing or jewelry on the affected arm. Make sure bra straps fit comfortably. If you choose to wear a breast prosthesis, make sure it is a lightweight one.
  • Avoid dramatic changes in temperature, such as long soaks in a hot tub.
  • Wear gloves when doing housework or gardening to protect your hands.
  • Avoid cutting cuticles on the hand of the affected arm. Push cuticles back gently instead.
  • If you must shave, use an electric razor.
  • Use thimbles when sewing.
  • Treat cuts, burns and insect bites promptly. Be alert for signs of infection: redness (including a red streak up the arm), swelling, drainage, warmth and fever.
  • Seek treatment immediately if an infection occurs. Alert your physician if swelling persists for longer than four days.

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Signs and symptoms

  • Feelings of tightness in the arm
  • Noticing that rings or other arm/finger jewelry has become tight
  • Weakness in the arm
  • Pain, aching or heaviness in the arm
  • Redness, swelling or signs of infection

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Treatment

Lymphedema is usually treated by physical methods and with medication.

  • Physical methods:
    • Support the arm in a raised position.
    • Undergo manual lymphatic drainage (a specialized form of very light massage that helps to move fluid from the end of the arm toward the trunk of the body).
    • Wear custom-fitted clothes that apply controlled pressure around the arm.
    • Clean the skin carefully to prevent infection.
  • Compression garments:
    • These should cover the entire area of swelling.
    • Compression pumps may be used with garments, but only under the supervision of a trained health care professional.
  • Medication:
    • Antibiotics may be used to treat and prevent infections.
  • Pain Management:
    • Pain is caused by the swelling and pressure on nerves, loss of muscle tissue and function, or scar tissue causing shortening of muscles and less movement in joints.
    • Pain may be treated with medications, relaxation techniques, and/or transcutaneous electrical nerve stimulation (TENS); however, the most successful treatment is to decrease the lymphedema.
  • Dietary Management:
    • Blood protein levels and weight should be monitored regularly, and patients should be encouraged to eat protein-rich foods.

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    Support

    Coping with lymphedema after breast cancer is especially difficult. Group and individual counseling can help by providing emotional support and information about ways to prevent lymphedema. Check with your health care provider to find a lymphedema support group near you. The information in this section is not meant to replace the individual attention, advice, and treatment plan of your oncologist and medical team.
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