Lymphedema After Breast Cancer: Prevention, Symptoms and Management

One in eight women in the U.S. (about 12.4 percent) will develop breast cancer during their lives, as well as a one in one thousand men. Breast cancer has a good prognosis if caught early before the malignant cells spread, and a combination of surgery, chemotherapy, medication and/or hormone therapy is often successful in treating it.

However, the treatment is not without side effects, and one of the most common byproducts of treating breast cancer is lymphedema, which occurs when one limb or area of the body swells. Below, we explain why breast cancer treatment can cause lymphedema, discuss symptoms and warning signs, offer prevention tips and finally cover management and treatment options if you already have lymphedema.

30% of patients who undergo breast cancer treatment will develop lymphedema.

Causes

Lymphedema occurs when a blockage in the lymphatic system causes a backup of lymph (aka lymphatic fluid) and therefore, swelling in a particular area of the body.

Treating breast cancer may result in lymphedema for several reasons. Lymph nodes and vessels are sometimes removed to slow or stop the spread of cancer, which can cause the lymph system to function differently, resulting in lymphedema. Chemotherapy can also cause the lymphatic system to malfunction if the radiation destroys nearby lymphatic tissue in addition to targeting the cancer. Any infection that interferes with the flow of lymph can cause swelling, and a tumor itself can result in lymphedema if it’s blocking part of the lymph system.

A frequent cause of secondary lymphedema is the surgical removal of lymph nodes, e.g. from the armpits of breast cancer patients.

Lymphedema may appear right after surgery or chemotherapy, or it may not manifest until months or years later. You should tell your doctor right away if you notice swelling after surgery or treatment, just in case it’s caused by something more severe than lymphedema, such as a blood clot or infection.

Chronic lymphedema develops slowly over time. Not only can lymphedema be uncomfortable, all that excess fluid can stop nutrients from reaching the cells, which in turn interferes with wound healing and even contributes to infections. If you’ve had treatment for breast cancer and start noticing the signs of lymphedema months or years later, don’t dismiss your symptoms. The earlier you catch lymphedema, the easier it is to treat, so don’t hesitate to reach out to your doctor if you notice the warning signs

Symptoms and Warning Signs

Lymphedema can manifest in a variety of ways. When your symptoms first start, your skin will probably keep its normal color and softness. However, as symptoms worsen, the affected area usually turns hot and red and the skin becomes hard and stiff. Common signs to watch out for are:

  • Swelling
  • Feeling heavy or tight areas of your body
  • Skin changing texture, feeling tight or hard or looking red
  • New aching, tingling, numbness or other discomfort in the area
  • Restricted movement in nearby joints or your eyelid(s), throat or lips
  • Trouble fitting into clothes in one area (such as a sleeve or pant leg feeling tight)
  • Collars, rings, watches and/or bracelets feeling tight even though you haven’t gained weight
  • Aching or discomfort
  • Recurring infections

Prevention

Thankfully, there are both post-treatment lifestyle changes you can make to reduce your risk of developing lymphedema in the first place.

Take baseline measurements: Before your surgery or treatment, see if your doctor, nurse, lymphedema therapist or another medical professional can measure the circumference of your limbs to get a baseline measurement on their natural size without any swelling. This will provide a mathematical reference you can refer to as you keep an eye out for the signs of lymphedema:

Engage in gentle exercises: After your rest period, your doctor may recommend that you work with a lymphedema therapist or other expert to devise stretching and strength-building exercises. Such an exercise program can help you regain strength and stamina and discourage lymph blockages by physically pumping fluid through your body with movement. However, it’s also important not to strain your body (as this can mobilize swelling/inflammation and lead to lymphedema) so it’s best to turn to an expert for advice as well as ask about compression sleeves to wear during activity.

Avoid injury and infection: Cuts, scrapes, burns, cracks—any break in the skin—can introduce bacteria into your already compromised immune system. Keep your skin clean and well-moisturized, especially around the treatment site, and wear gloves if you’re doing serious house or garden work that could injure your hands or arms. If you do notice a cut or break in the skin, wash the area thoroughly, apply a topical antibacterial ointment, cover it with a bandage and watch for signs of infection.

Avoid extreme temperatures: Hot tubs, ice baths, saunas, tanning beds and even treating the affected area with a hot or cold pack can damage your tissues and increase your chances of swelling and lymphedema. Try to keep your body at moderate temperatures as much as possible instead.

Elevate your limbs: Your doctor may recommend elevating the arm(s) on the side of the treatment site a few times daily (especially in the first 24-48 hours after surgery) to encourage blood, lymph and other fluids to drain back towards your core. To do this, you’ll gently prop your arm at a 45-degree angle on a stack of pillows, so it rests above the level of your heart and leave it there for 15-20 minutes at a time.

Lose weight if necessary: If you’re overweight or obese, studies show that you’re more likely to develop lymphedema. If you’re worried that your weight increases your risk of lymphedema, talk to your doctor about whether you need to lose some pounds, and what a safe and effective weight loss regimen might look like for you.

Wear compression garments during flight: When traveling by air, the decreased pressure that is experienced within the cabin can give rise to increased swelling. Compression garments provide external pressure on the extremity to support resorption and decrease the potential for fluid accumulation in the tissue.  Additionally, the sedentary nature of travel causes blood and lymphatic circulation to slow, standing, moving around the cabin and moving the affected limb frequently can help increase lymphatic fluid circulation and reduce swelling risk.

Management and Treatment

If you develop lymphedema, you will be prescribed complex decongestive physiotherapy (CDT) to reduce your swelling/edema and then maintain that decongested state. Complex decongestive physiotherapy is a combined form of therapy, both phases consisting of four elements.

The four elements of CDT are:

  • Skin care: People with lymphedema are at risk for cellulitis and other skin infections because their bodies are less able to fight infection. Bacteria can get into your body through a break in the skin, fungal infections (under nails), an existing wound or another entry point. Therefore, good skin care is so important.
  • Manual lymph drainage (MLD): A special type of gentle massage to improve lymph flow, direct fluid to other drainage pathways, and unblock or soften hard tissue. Manual lymphatic drainage aims to eliminate bacteria, toxins, viruses, wastes and excess water, and addresses blocks in lymphatic circulation, which may cause congestion and edema.
  • Compression therapy: Once your lymphatic vessels have been “awakened” with Manual Lymph Drainage (MLD), compression is applied to help move the extra fluid out of the limb, and to keep it from coming back into the limb. The idea behind compression therapy is to assist the tissue by applying pressure from the outside, which helps move the fluid into the lymphatic system, where it is filtered, concentrated, and returned to your body. The type of compression therapy you need depends on whether the swelling is mild, moderate or severe.
  • Exercise therapy as noted above

During CDT as well as after, your doctor may recommend a compression wrap and/or sleeve. These garments compress your arms to help move lymphatic fluid towards the heart and functioning lymph nodes. They may be designed as one continuous piece of fabric (compression sleeves) or as a brace-like construction that can be strapped around the limb (compression wraps). Compression sleeves are more lightweight to wear and faster to put on, while compression wraps allow for more size adjustment and can be easier to put on for those with mobility problems. It is important to wear a compression glove along with your arm garment to prevent fluid from moving towards your hard and resulting in swelling.

Compression Garments

Essity, a global hygiene and health company, has its U.S. headquarters in Charlotte. Under the brand name JOBST®, the company manufactures and sells compression garments for those with lymphedema. The JOBST® Bella™ armsleeves, gauntlets and gloves are particularly suited for those first entering into compression garments as well as post breast cancer intervention.

  • JOBST® Bella™ Lite garments are designed for patients with mild to moderate lymphedema who  are recently diagnosed, post-operative, or do not need the containment of a flat-knit garment. The lightweight fabric is breathable, comfortable, and easy to don – perfect for patients learning to make garment compliance part of their daily routine.

 

 

  • JOBST® Bella™ Strong garments are the ready-to-wear solution for patients with moderate to severe lymphedema, but do not need the containment provided by a flat-knit custom garment. Bella™ Strong makes JOBST® quality available to many patients by offering a wide range of sizes and styles, two lengths, three different compression classes, and more accessible pricing.

 

 

  • JOBST® FarrowWrap® Armsleeves are for mild to severe lymphedema patients who need a cost-effective solution that can adapt if their limb volume changes. FarrowWrap® uses patented Elastic Short-Stretch™ technology that gives the benefits of bandaging without the hassle. FarrowWrap® is perfect for patients with fluctuating edema who have difficulty donning traditional compression garments.

 

 

  • Bellisse® is a ready-to-wear compression garment for the torso that is designed to promote healing after breast surgery. Many breast cancer patients develop lymphedema, and many others experience significant fibrosis. This makes it critical that health care professionals use tools to help prevent this complication.

 

 

You are NOT alone!

Breast cancer treatment is already overwhelming enough without having to worry about lymphedema on top of it all. Thankfully, there are many actions you can take to prevent or treat lymphedema after breast cancer, starting with this guide.

To find out more about lymphedema and products for lymphedema, please go to www.jobst-usa.com. Additionally, visit ameswalker.com or a local durable medical equipment store to find the JOBST® Bella™ products.