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 handful of 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.
We recently created a guide to lymphedema, so you can check that out if you want non-breast cancer specific background information. In brief, 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 actually result in lymphedema if it’s blocking part of the lymph system.
Lymphedema may appear right after surgery or chemotherapy, or it may not manifest until months or years later. Lymphedema caused by breast cancer may also be temporary or chronic. Temporary lymphedema usually occurs right after surgery or chemo and goes away on its own in about a month. However, 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, and symptoms may not appear for months and even years after breast cancer treatment. 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:
- Feeling heavy or tight in particular 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
You should call your doctor if you notice any of the above lymphedema symptoms. You should also reach out to them if you experience any of the following changes, which can signal a blood clot or infection instead of/in addition to lymphedema:
- The affected area looks red, feels hot and/or swells suddenly
- You have a temperature of 100.5°F or higher (taken by mouth) that’s not caused by a cold or flu
- You feel new pain in the affected area without apparent cause
Thankfully, there are both surgical techniques and post-treatment lifestyle changes you can make to reduce your risk of developing lymphedema in the first place.
If your lymph nodes need to be removed via surgery as part of your cancer treatment, there are two recent techniques that can minimize the impact on the lymphatic system and reduce your chances of developing lymphedema. They are:
Sentinel lymph node biopsy (SLNB): The National Cancer Institute defines sentinel nodes as “the first lymph node(s) to which cancer cells are likely to spread from a primary tumor.” In SLNB, the sentinel nodes are removed and a biopsy is performed to see if the breast cancer has spread to the lymph nodes yet. If the biopsy comes back clear, the surgeon can remove fewer lymph nodes during the actual procedure, and therefore reduce the impact on the lymphatic system.
Axillary reverse mapping (ARM): There are lymphatic vessels in your arm and underarm area that drain into lymph nodes near your breast. In ARM, a blue dye is injected into the upper arm to help map the lymph nodes and vessels in the area. The surgeon will then try to work around the lymphatic system as much as possible during the procedure.
Beyond surgical techniques, there are steps you can take after surgery that also reduce your risk of developing lymphedema, including:
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. Then you won’t have to guess whether or not you’re swelling after surgery. You’ll have a mathematical reference you can refer back to as you keep an eye out for the signs of lymphedema.
Give yourself a break: In the days following surgery, try to rest and keep from lifting the arm above your shoulder or picking up heavy objects. While limiting your activity may make you feel restless, it’s important to let the treatment site heal without putting additional strain on it. Your doctor will be able to advise how soon you can resume activity. It’s usually in the range of 7-10 days.
Engage in gentle exercises: After your rest period is up, 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.
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.
Also 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 or not you need to lose some pounds, and what a safe and effective weight loss regimen might look like for you.
Management and Treatment
As we said above, the best way to treat lymphedema is to catch it early and let your doctor know if you experience any symptoms. However, if you do develop lymphedema, there are practical steps you can take to manage your symptoms so it doesn’t interfere with your life and treatment. Some of these techniques are the same as those for preventing lymphedema, such as avoiding injury and infection, elevating the affected arm(s), exercising and stretching and managing your diet and weight.
However, other strategies can specifically be put to use after lymphedema symptoms appear, including:
Compression sleeves and wraps: These garments compress your arms and legs to encourage the healthy flow of lymph. 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.
Whether you choose a wrap or a sleeve, be sure to take your measurements so you can choose the right size and level of compression for your needs. The Bella Lite and Bella Strong armsleeves and gauntlets are particularly popular among women, and they’re a good place to begin if you’ve never shopped for compression gear before.
JOBST Bella Lite products provide gradient compression to assist in the management of lymphedema and other edemas. The garments are made from soft and air permeable fabric with a lightweight knit construction. The armsleeves and gauntlets are easy to don and comfortable to wear for long periods of time. The armsleeve is available both with and without silicone band, and it comes in two lengths, regular and long.
Meanwhile, Bella Strong products take compression therapy to a whole new level of comfort, without compromising medical efficacy. JOBST® Advanced Comfort fabric quickly wicks moisture away from the skin, while the Comfort Flat wristband on the armsleeve eliminates rolling and improves durability. The extended wrist on the gauntlet decreases constriction, and the garment also features flat seams for increased comfort. Bella Strong armsleeves are also available in regular and long, and each comes with a JOBST® Donning Aid to assist in putting on the product.
Pneumatic compression therapy: A more involved type of compression therapy, pneumatic compression therapy requires an air pump connected to inflatable sleeves that cover your arms and/or legs. The pump automatically and intermittently inflates the sleeves to put pressure on your limbs and push lymph back to your core. Since the air pump has to be plugged into a power outlet, pneumatic compression therapy is much less portable, and is usually restricted to a few sessions a day when you can afford to sit or lie still.
Massage therapy: A massage technique called manual lymph drainage may help lymph drain from your limbs by physically kneading the muscles and the lymph vessels they contain. See if there is a masseuse trained in this technique in your area. Do be aware that massages can introduce sweat and bacteria into the affected area, so you should avoid it if you have a skin infection or blood clots.
People with breast cancer are often apprehensive about two common activities–exercise and flying. For a long time, there was concern that exercise increased the risk of developing lymphedema, or worsened symptoms if you already had the condition. However, after breast surgery and an appropriate rest period, arm exercises don’t appear to increase your risk of lymphedema—and, in fact, it might even help reduce symptoms, as stated above. Your doctor will be able to advise you on what exercises you can do during and after breast cancer treatment.
As for flying, you can still travel during breast cancer treatment for the most part, though you should arrive at the airport early so you have time to complete a secondary screening if needed. You can request a private pat-down screening away from public areas if you’d prefer not to go through the body scanner. You don’t need to remove a compression sleeve when you go through security, but a TSA agent may give you an additional screening with a hand-held metal detector or a pat-down. Your doctor can advise you on your overall fitness for flying.
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.