Lymphedema is an accumulation of
lymphatic fluid that causes swelling in the arms
and legs. This condition occurs when the lymphatic
vessels are impaired and the lymph fluid collects
in the tissues of the extremities. Lymphatic vessels
are similar to veins, but rather than circulating
blood, they carry lymph fluid through the body.
Lymph fluid contains oxygen, protein, glucose
and white blood cells that help fight infection.
If left untreated, lymphedema can interfere with
wound healing, promote infection, and lead to
a chronic inflammatory condition resulting in
fibrosis, or hardening of the tissues.
Lymphedema is described as being primary or secondary.
Primary lymphedema results from developmental
abnormalities in the lymphatic system, usually
present at birth. Secondary lymphedema can result
when the normal functions of the lymphatic system
have been disturbed by surgery, trauma, radiation,
cancer, or other similar conditions. Anyone who
has had breast surgery in combination with lymph
node removal, biopsy or radiation therapy is at
risk of developing lymphedema. This risk varies
individually based upon the number of lymph nodes
removed, the amount of radiation received, and
how the remaining lymphatic system functions to
compensate for the disturbance.
Some swelling in the breast and arm
area is normal during the first few weeks following
breast surgery. Chronic swelling, or lymphedema
of the arm can occur as soon as immediately after
surgery, or as late as many years after cancer
therapy has concluded. It is important to know
the signs of lymphedema. They include:
feeling of tightness in the arm
pain, aching or heaviness in the arm
swelling and redness of the arm
jewelry or clothing do not fit
reduced ability to move the arm, hand, wrist,
Seek medical care immediately upon
noticing any of the above signs. Early recognition
of lymphedema and the beginning of physical therapy
can relieve the swelling and prevent progressive
disease. In addition, contact your physician immediately
if you notice: a rash, blistering, redness or
warmth in the arm; any swelling that lasts one
to two weeks; or a temperature of 100.5 or above
without any cold or flu symptoms. If lymphedema
is diagnosed and treated early, the chances for
improving the condition are much greater than
if the swelling goes untreated.
The American Cancer Society
and the National Cancer Institute (www.nci.nih.gov)
both have very thorough guidelines available that
can help breast cancer patients reduce their risk
of developing lymphedema. The following are recommendations
to follow soon after breast cancer surgery:
Use the arm in normal activities soon after surgery
to facilitate full range of motion.
Following surgery, raise the arm above the level
of the heart for 45 minutes, two to three times
a day while lying down. Use a pillow to rest your
arm so that the hand is higher than the wrist,
and the elbow is slightly higher than the shoulder.
Keep the arm clean. Use lotion such as Nivea or
Having injections, blood tests, or blood pressure
testing in the affected arm should be discussed
with your physician.
Avoid tight jewelry, clothing or elastic bandages
on the affected arm or fingers.
Avoid any injuries to the affected arm such as
cuts, sunburn, insect bites, or scratches. Wear
gloves while doing housework, gardening or other
work that could result in minor injury. Wear protective
sun block and covering.
Do not use any chemical underarm hair removers.
An electric razor is recommended.
When manicuring nails, avoid cutting cuticles.
Please inform your manicurist.
Avoid extreme temperature changes when bathing
or washing dishes. Do not use hot tubs or saunas.
Avoid heavy lifting with the affected arm. Avoid
heavy handbags or bags with over-the-shoulder
Avoid vigorous, repetitive movements against resistance
with the affected arm.
Exercise regularly. Rest the affected arm if it
becomes sore or tired.
Maintain a balanced diet and an ideal weight.
Obesity increases the risk of developing lymphedema.
A careful examination to determine
the cause of this condition is very important
in determining the appropriate treatment. If the
lymphedema is caused by an infection, antibiotics
will be used to fight the infection. If not caused
by infection, the treatment may include massage
therapy, physical therapy, compression therapy,
patient education and emotional support. The use
of these various therapies is called Complex Decongestive
Therapy or CDT. CDT includes a specialized massage
therapy called Manual Lymph Drainage, MLD, which
stimulates the movement of lymph to healthy lymph
vessels. Therapists certified in MLD focus on
gently massaging the connective tissue rather
than the more standard muscle tissue massages.
Compression bandages and sleeves help to increase
drainage and prevent fluid from refilling in the
Lymphedema, as with many chronic
conditions can be difficult emotionally. Coping
with a chronic condition can be stressful. Support
groups, therapy and education can all help make
living with lymphedema easier.
If you have additional questions
or concerns, please call us at 847-797-9000