Lymphedema after Breast Cancer Surgery

Thomas L. Poulin, M.D., is a General Surgeon at General and Vascular Surgery in South Bend, Indiana.
Roger Klauer, M.D., is Medical Director of Memorial Lymphedema Treatment Program in South Bend, Indiana.
 
Article originally appeared in 2008 Regional Breast Care News

 

What is it? How do I avoid it?  How do I treat it?

Lymphedema is one of the more common and troublesome complications of breast surgery, which results when the disrupted lymphatics do not allow clearing of all the lymphatic fluid from the upper extremity or the breast region. It can be quite minor and develop slowly over a period of time, or can be quite severe and associated with significant disability. After surgical removal of lymph nodes or radiation therapy to a lymph node area, there is a lifetime potential for the development of lymphedema. It can develop soon after surgery or radiation, or can take months or even years to develop. The highest risk for lymphedema occurs when surgical removal of the lymph nodes plus radiation to the lymph node region are both required. Once the process has started, it cannot be cured but can usually be managed successfully with appropriate care. Some swelling is normal after surgery, but this will generally resolve in three to six weeks. Normal activity with the arm, as well as intermittent elevation and exercise to regain normal range of motion of the arm, are all effective in reducing swelling in the immediate post-radiation or post-surgical period. Fortunately, lymphedema has become less common in recent years due to our ability to limit the number of lymph nodes removed by the use of a technique called the “sentinel lymph node biopsy.”  This technique allows the sampling of the lymph nodes most likely to filter out any cancer cells that have escaped into the lymphatic system. If the sentinel lymph nodes are not involved, it is usually not necessary to remove the remaining lymph nodes, which reduces the risk of lymphedema while retaining the ability to properly stage the cancer.

Early signs of lymphedema include:

  • Heavier/full feeling in the arm
  • Tight skin feeling
  • Less flexibility of fingers, hand or wrist
  • Onset of tightness in rings, watches, bracelets or clothing 

Maneuvers to help prevent or control lymphedema include:

  •  Do everything possible to protect the skin of the arm and hand
    • Use sunscreens, protective clothing to avoid sunburn
    • Wear protective cooking mittens when handling hot foods, reaching into hot ovens, etc.
    • Use insect repellents to prevent insect bites
    • Use protective gloves when doing household chores and gardening activities to avoid cuts, scratches and contact with chemicals.
    • Avoid excessive heat, such as hot tubs
    • Practice good hygiene of your hands, nails, cuticles, etc.
    • Consider an electric razor to remove underarm hair as opposed to hair removal creams or razors
    • If possible, avoid blood draws or injections in the involved arm
  • Avoid constriction of the affected arm
    • Blood pressure should be checked in the opposite arm if possible
    • Restrictive jewelry and clothing should be avoided
  • Any small skin injuries should be cleaned, and over-the-counter antibacterial creams used to avoid infection
  • Consult a physician promptly if there is any sign of infection or cellulites (redness, warmth and/or increasing pain) in the hand, arm or breast. You may need to be placed on an antibiotic.
  • Regular exercise is important, but overexertion can produce swelling in the affected arm. If your increased activity or exercise program causes signs of lymphedema, you will need to back down.
  • Avoid weight gain. Weight gain, along with recurrent bouts of infections in the arm, are the two items most likely to increase your chances of developing lymphedema.
  • Wearing a compression sleeve when flying is often recommended for long distance or frequent flights. 

Any early referral to a lymphedema specialty clinic is important if your surgeon feels you are at significantly high risk for lymphedema, or if there are signs of lymphedema. The certified lymphedema therapist will demonstrate exercises, breathing techniques, skin care, resting postures that are of value and prescribe the appropriate compression garment.