Lymphedema After Breast Cancer Surgery

This content has been reviewed and approved by

William J. Gradishar, MD FACP
Director, Breast Medical Oncology, Professor of Medicine
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine

What is the lymphatic system?

Your lymphatic system consists of many vessels that carry lymph throughout your body. Often during a lumpectomy or mastectomy, some or all of the lymph nodes under your arm may be removed. The lymph nodes under your arm (called your axillary lymph nodes) drain lymph from your upper arms, the majority of your breast, your neck, and your underarm. The lymph nodes help to filter excess fluid, bacteria, and by-products of infections.

What is lymphedema?

Whenever the normal drainage pattern in your lymph nodes is disturbed or damaged (often during surgery to remove the lymph nodes), your arm may swell. Radiation and chemotherapy may also cause swelling of your arm. This swelling, caused by the buildup of too much fluid, is called lymphedema.

When the lymph nodes under your arm have been removed, you are at higher risk for lymphedema. Lymphedema may occur immediately after surgery, or months or years later. Not every woman who has a mastectomy gets lymphedema.

There are several types of lymphedema. A sudden and mild type of lymphedema occurs within a few days after surgery and usually lasts a short period of time. A sudden and more painful type of lymphedema can occur about 4 to 6 weeks after surgery. But the most common type of lymphedema comes on slowly and is painless and may occur 18 to 24 months after surgery.

How is lymphedema diagnosed?

There are no specific diagnostic tests for lymphedema. Your doctor will take a medical history and do a physical examination. The medical history may include questions regarding the following:

• Past surgeries
• Problems after the surgeries
• Onset of symptoms (when did the swelling start?)
• History of edema (bad swelling)
• Current medications
• Other medical conditions, such as high blood pressure, heart disease, or diabetes

What are the symptoms of lymphedema?

The main symptom of lymphedema is swelling of your affected arm. The degree of swelling may vary. Some women may have significant swelling (edema), with the affected arm being several inches larger than the other arm. Other women have a milder form of edema, with the affected arm being slightly larger than the other arm.

In addition to swelling of your arm, the following are the most common symptoms of lymphedema. But each woman may experience symptoms differently. Symptoms may include:

• Feeling of fullness or tightness in your arm
• Aching or pain in your arm
• Swelling in your hand (your rings may not fit any more)
• Weakness in your arm

The symptoms of lymphedema may resemble those of other medical conditions. Consult your doctor for a diagnosis.

Treatment for Lymphedema

Treatment for lymphedema depends on how bad it is. Preventing and controlling lymphedema plays an important role with this condition because there is no cure. Treatment may include the following:

• Exercise - Exercising helps to restore your flexibility and strength, and improves lymph drainage. Your doctor and/or physical therapist will recommend the type of exercises.
• Bandage - Wearing a customized compression sleeve or elastic bandage may help to decrease the buildup of fluid if lymphedema is present. It is especially important to wear a compression sleeve or elastic bandage on your arms during exercise or physical exertion, such as when gardening or cleaning house.
• Arm pump - Applying an arm pump often helps to increase the fluid flow in your lymphatic vessels and keep the fluid from collecting in your arm.
• Diet - Eating a well-balanced diet and controlling your weight are important parts of treatment.
• Keep your arm raised - Keeping your arm raised above the level of your heart, when possible, allows gravity to help drain the extra fluid.
• Prevent infection - Following preventive measures, such as good skin care, to protect your arm from infection and skin breakdown is important.

Women with breast cancer who perform good skin care and exercise properly after mastectomy are less likely to get lymphedema.

Preventing and Controlling Lymphedema

Protecting your swollen arm is very important after breast surgery. Poor drainage of your lymphatic system may cause your arm to be more prone to infection and to be less sensitive to very hot and very cold temperatures. If you have lymphedema, you should avoid injury and infection. And you should learn which activities put too much pressure on your arm. Protective steps include the following:

• Make sure that all injections are given and blood tests are drawn in your other (unaffected) arm.
  
• Avoid wearing nightgowns or clothing with elastic cuffs.
  
• Carry your handbag or heavy packages in your other arm.
  
• Use an electric shaver when shaving your underarms.
  
• Avoid sunburns and other burns to your arm.
  
• Make sure that all blood pressure tests are performed on your other arm.
  
• Wear gloves and a compression sleeve or elastic bandage when gardening and when using strong household detergents.
  
• Clean the skin of your arm daily and apply lotion. When drying your arm, be gentle, but thorough.
  
• Keep your arm elevated when possible.
  
• Do exercises regularly to improve drainage, but first consult with your doctor or physical therapist. Wear a compression sleeve/elastic bandage during exercise.
  
• Eat a well-balanced, low-salt diet.
  
• Avoid very hot or cold temperatures on your arm, such as heating pads or ice packs.
  
• Take proper care of your fingernails, and do not cut your cuticles.
  
• Clean all cuts with soap and water, and then apply antibacterial ointment and a sterile dressing.
  
• Protect your fingers from needle pricks and sharp objects. Use a thimble when sewing.
  
• Avoid vigorous, repetitive movements against resistance (such as scrubbing, pulling, or pushing) with your arm.

Tell your doctor immediately if you get any signs of infection, such as redness, pain, heat, extra swelling, or fever.