Lymphedema is a complication of breast cancer treatment in some women. For patients with lymphedema, physical therapy is an essential component of treatment.
What is Lymphedema?
Lymphedema after breast surgery is swelling in the arm, breast or torso following treatment. This condition is caused by an accumulation of protein-rich fluid from lymph node removal or damage to lymph-collecting vessels during surgery or radiation. Lymphedema can result in swelling of the arm shortly after surgery or years later. It can produce pain and restricted motion in the arm or shoulder.
Lymphedema can also be due to the treatment of other cancers, not just breast cancer. Lymphedema of the legs, lower trunk or genitalia can develop after surgery or radiation for treatment of lymphoma, bladder or vulvar cancer.
It is estimated that 5-45% of women who have had breast cancer surgery will develop lymphedema. It is impossible to predict in advance which women will experience this condition. Lymphedema is not related to the degree of swelling after surgery or during radiation therapy. Women who have more collateral lymph vessels bypassing the axilla (armpit) are less susceptible.
Occasionally, the onset of swelling can develop 15-30 years after surgery. For most women, the swelling progresses gradually over months following surgery.
The best strategy for preventing lymphedema before it occurs is with the arm and hand exercises prescribed by your care team following surgery and radiation treatment.
To reduce the risk of additional instances of swelling and pain, needle sticks and blood pressure should be done on the arm opposite your breast surgery. Precautions should also be taken against sunburn, insect bites and minor cuts.
How Can Lymphedema Be Treated?
Left untreated, symptoms of lymphedema tends to worsen and can result in increased risk of skin infections. Treatments can involve special sleeves designed to reduce the risk of swelling, sleeves hooked to compression pumps for manual removal of accumulated fluid, or in extreme cases, performing surgery.
What has proven most effective in treatment is Manual Lymphatic Drainage (MLD) massage. Using light manual pressure, the therapist redirects fluid toward areas without damaged lymph nodes or pathways. Compression bandages can help maintain the progress made during the massage. In addition, meticulous skin care and exercise are a part of successful treatment.
On average, intensive treatment includes a couple of hours each day for two to four weeks. After initial treatment, patients are fitted with a compression garment, taught self-massage and are reevaluated periodically.
Treatment for mild cases of lymphedema is less intensive, but still requires considerable commitment and attention by the patient.
Lymphatic Drain Massage
Also called lymphatic drainage or manual lymph drainage, this gentle pressure technique is used to treat lymphedema, an accumulation of fluid that can occur after lymph nodes are removed during surgery, most often a mastectomy for breast cancer.