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How to Manage Lymphedema After Breast Cancer

How to Manage Lymphedema After Breast Cancer

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    What is lymphedema?
    What is the likelihood of developing lymphedema after cancer?
    What are the symptoms of lymphedema?
    What is the difference between temporary swelling and lymphedema?
    What factors increase your risk of lymphedema?
    How do you reduce your risk?
Lymphedema Management
    Massage
    Compression
        Multi-Layer Compression Bandaging
        Compression Garments
    Exercise

What is lymphedema?

Lymph vessels run throughout the body, much like blood vessels. They absorb lymph fluid from the tissue and move it to the lymph nodes to be filtered. During breast cancer surgery, some lymph nodes may be removed to check for cancer cells. Radiation therapy can also damage the lymph system and lead to blockages.

Both of these procedures can cause fluid to build up and cause swelling (edema). The swelling can be large and uncomfortable. This secondary lymphedema often occurs in the chest area or the arm, due to the location of the lymph nodes that are damaged.

What is the Likelihood of Developing Lymphedema After Cancer

What is the likelihood of developing lymphedema after cancer?

The statistics vary based on different research and studies. One study that followed 631 breast cancer patients over 5 years found that 42% developed lymphedema (23% mild, 12% moderate/severe, 2% chronically moderate or severe)5.

Another study looked at rates depending on dissection. The sentinel lymph node dissection (SLNB) – which removes fewer nodes – is employed whenever possible and is associated with lower lymphedema risk (3%)3. In some circumstances, however, a greater number of lymph nodes must be removed (ALND) and the lymphedema risk is higher (19%)3.

What are the symptoms of lymphedema?

  • Swelling in the arm, chest, armpit, or hand
    • Jewelry, clothing, or bras may feel tighter than usual
  • Feelings of tightness or heaviness in the upper limb
  • Thickening or firmness of the skin on the affected area
  • Decreased flexibility in the shoulder, elbow, wrist, or fingers
  • Weakness or fatigue in the arm

What is the difference between post-operative swelling and lymphedema?

Some swelling, also known as postoperative edema, can occur after surgery or during and following radiation therapy. This should decrease in the weeks immediately after your treatment. Talk to your care team if you are concerned about your level of swelling.

A visit to a lymphedema therapist for baseline measurements – either before your surgery or immediately after – can help you learn how to identify early signs of lymphedema (chronic swelling). Being active after surgery will help you recover. Talk to your doctor or consult a physical therapist for specific exercise recommendations.

What factors increase your risk of lymphedema?

  • Removal of a large number of axillary lymph nodes
  • Radiation therapy to the axillary lymph nodes
  • Cancer cells in a large number of axillary lymph nodes
  • Infection in the area after surgery
  • Obesity
  • Severe injury, like a serious burn or wound, to the affected arm
  • Genetic predisposition
  • Recurrent tumor

Factors that Don’t Appear to Increase Your Risk

The type of surgery (lumpectomy vs. mastectomy) doesn’t seem to impact the development of lymphedema. Whether or not a woman has reconstructive surgery after a mastectomy and the type of breast reconstruction chosen also doesn’t affect your risk.

How do you reduce your risk?

Avoiding injury after surgery is essential. If you have an infection, burn, or injury, your body responds by sending extra white blood cells in fluid to the area. Missing or damaged lymph nodes can have a hard time moving this extra fluid, which can trigger or worsen lymphedema. Since we can’t always avoid injury, here are some guidelines:

These tips can help reduce your risk:

  • Have blood draws, shots, and IVs done in your unaffected arm (when possible)
  • Have blood pressure taken on your unaffected arm, if possible
  • Exercise regularly, but don’t overexert yourself

Skin care:

  • Keep the area clean and use a moisturizing lotion regularly
  • Clean and protect any open areas (cuts, hangnails, scratches, etc.)
  • Wear a sunscreen with at least 30 SPF daily
  • Avoid cutting your cuticles, push them back with a cuticle stick instead
  • Wear gloves when gardening, doing yard work, working with harsh chemicals, or using steel wool
  • Use insect repellent to avoid bug bites
  • Be careful when shaving your under arm, consider using an electric razor
  • Wear a thimble if sewing to avoid needle pricks
  • Keep your pet’s nails short to avoid scratches

Report any signs of infection (redness and warmth in the infected area, fever, pain, and flu-like symptoms). Call your doctor right away, as cellulitis can lead to or worsen lymphedema.

Avoid extreme temperatures:

  • Avoid high heat, like hot tubs and saunas, and talk to your doctor before using hot or cold packs (both heat and cold can damage tissue)
  • Test water with your unaffected arm before bathing – your affected arm might be less sensitive to temperature than it used to be

Protect your circulation:

  • Don’t wear tight or heavy jewelry or clothing with constricting elastic
  • Avoid using shoulder straps on your at-risk side when carrying briefcases or purses
  • Ask your doctor if you should wear a compression sleeve during air travel

Lymphedema Management

If you have lymphedema, management is an important step for your well-being and quality of life. Diuretics (water pills) won’t relieve the swelling because it’s lymph fluid, not water. A certified lymphedema therapist will help you reduce swelling by following a treatment regimen called complex decongestive therapy (CDT).

Massage

Massage is the first step to reduce swelling. The specific massage manipulation used for lymphedema is called manual lymphatic drainage (MLD). MLD stretches the tissue to increase the flow of lymph fluid through your system and reduce swelling. The strokes should be gentle and slow during decongestion. A professional will do the massage, but they might also teach you how to do a self-massage at home between treatments. A flexible measuring tape can help you track reductions and fluctuations in swelling.

Watch an example of MLD self-massage!

Compression

Compression can help you maintain the reductions in swelling. Lymphedema from breast cancer treatment commonly occurs in the arm, but it can also affect the chest. Compression can be used on both of these areas. Multi-layer bandaging is often used first, while a garment might be used after your lymphedema is better controlled.

Multi-Layer Compression Bandaging

The multi-layer compression bandaging process uses a variety of bandages to provide even compression, which reduces the amount of fluid that can accumulate. Begin wrapping distally (near the fingers) and continue proximally (toward the heart) with even tension. The size of the bandages are specific to create a variable pressure and move fluid out of the limb.

Multi-Layer Compression Bandaging

Layer 1: Skin Protection

Layer 2: Fingers/Toes

  • Mollelast
    • You should individually wrap the fingers and toes to help prevent the swelling from spreading.

Layer 3: Padding

Layer 4: Focal Compression

Layer 5: Short Stretch Bandages

  • Rosidal K
    • Short stretch bandages give high working pressure and low resting pressure. These provide the compression needed in multi-step bandaging. Highly elastic bandages like ACE bandages should not be used, their high resting pressure makes them hard to tolerate and allows fluid to enter.

Layer 6: Tape

  • Silkafix Tape
    • Tape secures the bandaging in place. You shouldn’t use clips because they could puncture the skin and lead to infection.

Consider buying a Bandaging Kit so you have everything you need for bandaging. Each kit comes with two sets, so you can wash one and wear the other.

Compression Garments

Garments are often worn when your lymphedema is better controlled. They still provide compression, but are easier to don than bandaging. ReadyWrap Arm and ReadyWrap Gauntlet are simple ways to get the compression you need during the day.

Check out this video to see how easy ReadyWrap garments are to put on!

If your therapist recommends compression at night, try the TributeWrap Wrist to Axilla Garment and add a glove for full coverage. Wearing compression garments while resting or sleeping helps prevent fluid buildup so you can easily don your day garments when you wake up.

Or use a foam elevator to support and elevate the limb while resting (no need to elevate if your limb is compressed).

Exercise

Research has shown that exercise does not increase your risk of lymphedema4. In fact, moderate exercise might offer protection for real-life situations like carrying groceries or lifting a child. However, obesity increases your risk of lymphedema, so exercise and healthy eating are important to help avoid lymphedema.

Sarah Stolker

“Inactivity puts patients at a greater risk than over-exertion.” - Sarah Stolker, MSPT, CLT-LANA

If you have lymphedema, you should wear a compression sleeve during exercise. Start at a low intensity and slowly increase over time. Resistance bands are an easy way to work your upper extremities while controlling the resistance. Start light - and talk to your doctor before beginning a new exercise program.

References
1.American Cancer Society. (2016). For People at Risk of Lymphedema. https://bit.ly/2tuDXqG
2. American Cancer Society. (2016). For People With Lymphedema. Retrieved from https://bit.ly/2tt8llx
3. American College of Surgeons. (2013). Breast Cancer Patients’ Fear Exceeds Risk. Retrieved from https://bit.ly/2KnutY3
4. National Cancer Institute. (2015). Lymphedema (PDQ®)–Health Professional Version. Retrieved from https://bit.ly/2KjbDOA
5. Norman, S. A., Localio, A. R., Potashnik, S. L., Simoes Torpey, H. A., Kallan, M. J., Weber, A. L., … Solin, L. J. (2009). Lymphedema in Breast Cancer Survivors: Incidence, Degree, Time Course, Treatment, and Symptoms. Journal of Clinical Oncology, 27(3), 390–397. http://doi.org/10.1200/JCO.2008.17.9291
6. Susan G. Komen. (2018). Lymphedema. Retrieved from http://sgk.mn/2rFdQPx

Medical Disclaimer: The information provided on this site, including text, graphics, images and other material, are for informational purposes only and are not intended to substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other healthcare professional with any questions or concerns you may have regarding your condition.