Lymphedema After Breast Cancer: Causes, Prevention, and Management

One in eight women in the U.S. will develop breast cancer during their lives, as well as a one in one thousand men1. 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 it1.

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 swells2.

30% of all patients who undergo breast cancer treatment will develop lymphedema2.

Causes

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 system3.

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, but that excess fluid can stop nutrients from reaching the cells, which in turn interferes with wound healing and even contributes to infections3. 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!

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 can be found here.

 

Prevention4

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, ask your medical professional to measure the circumference of your limbs to get a baseline measurement on your 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 is 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 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.

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 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 are overweight or obese, studies show that you’re more likely to develop lymphedema. Talk to your doctor about whether you need to lose weight, 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 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 and/or moving the affected limb frequently can help increase lymphatic fluid circulation and to reduce the risk of swelling.

 

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. To read more about CDT, click here. During CDT as well as after, your doctor may recommend a compression wrap and/or sleeve. An explanation of the different compression garment types and styles can be found here.  

 

You are NOT alone!

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