Lymphedema occurs when the lymphatic system does not function optimally. Many of my patients will ask, “It’s the lymph nodes, right?” Yes, that is correct. However, it is much more than the lymph nodes. The lymphatic system is an important aspect of the immune system and protects the body from foreign substances. It is complex and includes an extensive network of lymph vessels.
In a properly functioning lymphatic system, excess fluid that is collected from space between tissues moves through the lymph vessels and the lymph system as the vessels are compressed by surrounding muscles. The lymph nodes serve as the filters and remove the bacteria, waste, and debris. The fluid is then drained into the bloodstream.
SECONDARY LYMPHEDEMA FOLLOWING BREAST SURGERY
With lymphedema, an abnormal buildup of fluid occurs. This buildup of fluid causes swelling or lymphedema. There are two types of lymphedema: primary and secondary. Secondary lymphedema occurs when there is a blockage or interruption of the lymph fluid caused by breast surgery. People may experience lymphedema after lumpectomy, mastectomy, or modified radical mastectomy with axillary node dissection and/or radiation to a lymph node region. Lymphedema can also occur after breast augmentation or breast reduction, as this surgery can also impair the lymphatic vessel pathways.
Lymphedema can develop almost immediately after surgery or even years later. Some swelling may occur in the first few weeks after surgery, and that is normal.
It is difficult to find accurate statistics on prevalence as lymphedema is often not diagnosed accurately and often goes unreported. The US Department of Health and Human Services estimates that lymphedema affects about 100 million people around the world, including at least three million Americans.
There are several signs and symptoms associated with lymphedema. Doctors and patients should be alert to swelling following breast cancer surgery. This typically occurs in the arm, hands, fingers, chest, torso, and/or shoulders. At times, this swelling may initially occur after a trauma, such as a cut, bruise, or even following sunburn, and after sports injuries.
A diagnosis is made after a thorough examination, including review of medical history. Often the first one to notice the signs and symptoms of lymphedema is the patient. She may present with:
- A feeling of fullness and heaviness;
- Skin tightness;
- Clothes and jewelry that begin to feel tight in the arms/chest/trunk; and
- Decreased flexibility.
CDT IS TREATMENT OF CHOICE FOR LYMPHEDEMA
If a patient is diagnosed with lymphedema, the best course of action is a program of complete decongestive therapy (CDT) provided by a certified lymphedema therapist who has completed a minimum of 135 hours of training.
CDT consists of manual lymphatic drainage (MLD), meticulous skin care, multilayered compression bandaging, and patient education. If the initial signs and symptoms are a result of an infection, antibiotics are often prescribed.
Lymphedema cannot be cured, but it can be controlled and managed well. To manage the condition, your patient must:
- Practice good nutrition;
- Maintain an ideal body weight;
- Exercise regularly;
- Avoid infections by protecting her skin;
- Watch for signs of possible infection, including fever, redness, warmth, or increased pain in addition to swelling;
- Not wear tight-fitting clothing, jewelry, or shoes;
- Avoid heavy lifting with the affected arm. (If she carries a purse, tell her to switch to the unaffected side.); and
- Maintain good skin care.
Patients should know that, while not a guarantee, taking these steps could possibly prevent lymphedema. They are vital in the presence of lymphedema.
LYMPHEDEMA CAN’T BE CURED, BUT CAN BE CONTROLLED
If your patient does develop lymphedema, advise her to:
- Wear a compression sleeve daily, especially if she is flying because changes in atmospheric pressure in flight can exacerbate lymphedema;
- Avoid extremes in temperatures;
- Elevate her arm when possible; and
- Avoid repetitive motions such as exercise with weights, pushing and, pulling weighted objects (as in vacuuming).
Physicians should also take care not to measure blood pressure, give injections, or draw give blood on the affected limb.
Without treatment, swelling can increase and tissues can harden. This could result in decreased mobility and function of the affected extremity. It could also lead to chronic infections. For this reason, it is very important to receive treatment in a timely manner. The cosmetic and reconstructive breast surgeon can serve as vigilant gatekeepers and advocates for their patients. Knowing the signs and symptoms of lymphedema and discussing risk with your patients during the initial consultation can help better prepare them for what lies ahead. Breast surgeons likely have a strong referral network for any of the postsurgical issues that could arise. A certified lymphedema specialist should be one of them.
Cathy Kleinman-Barnett, MOTR/L, CLT-LANA, is a lymphedema specialist at the Lymphedema/Edema Management Program at Northwest Medical Center in Margate, Fla. She is a Vodder-certified lymphedema therapist and is also certified by the Lymphology Association of North America. She can be reached at (954) 978-4180 or by e-mail: .