Lymphedema After a Mastectomy

What is the lymphatic system?

The lymphatic system is made up of many vessels that carry lymph fluid throughout the body. Lymph is a clear, colorless fluid that contains water and a few blood cells. It starts in many organs and tissues. The lymphatic system is part of your immune system. It helps to protect and maintain the fluid of your body by filtering and draining lymph and waste products away from each body region.

Often during a lumpectomy or mastectomy, some or all of the lymph nodes under the arm may be removed. The lymph nodes under the arm are also called the axillary lymph nodes. They drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. The lymph nodes help to filter extra fluid, bacteria, and by-products of infections.

What is lymphedema?

Whenever the normal drainage pattern in the lymph nodes is disturbed or damaged (as often happens during surgery to remove the lymph nodes), severe swelling of the arm may occur. Radiation may also damage lymph nodes and cause swelling of the arm. This swelling, caused by an abnormal collection of too much fluid, is called lymphedema. The swelling can be noticed in the arm, chest, and breast area on the side of surgery.

When the lymph nodes under the arm have been removed, a woman is at higher risk of lymphedema for the rest of her life. Lymphedema may occur immediately following surgery, or months or years later. Not every woman who has a mastectomy will experience lymphedema.

There are several types of lymphedema. The acute, temporary, and mild type of lymphedema occurs within a few days after surgery and usually lasts a short period of time. The acute and more painful type of lymphedema can occur about four to six weeks following surgery. However, the most common type of lymphedema is slow and painless and may occur 18 to 24 months or more after surgery.

How is lymphedema diagnosed?

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

• Past surgeries

• Problems following the surgeries

• Onset of symptoms (When did the swelling appear?)

• History of edema (severe 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 the affected arm. The degree of swelling may vary. Some people may experience severe swelling (edema) with the affected arm being several inches larger than the other arm. Others will experience a milder form of edema with the affected arm being slightly larger than the other arm.

In addition to swelling of the affected arm, the following are the most common symptoms of lymphedema. However, each individual may experience symptoms differently. Symptoms may include:

• Feeling of fullness or tightness in the affected arm, chest, or armpit area

• Aching or pain in the affected arm

• Swelling in the hand (may be evidenced by rings that no longer fit)

• Weakness in the affected arm

The symptoms of lymphedema may look a lot like other medical conditions. Consult a doctor for a diagnosis.

Treatment for lymphedema

Treatment for lymphedema depends on the severity and extent of the condition. Prevention and controlling lymphedema play an important role with this condition since there is no cure.

Treatment may include the following:

• Exercise. Exercise helps to restore flexibility and strength, and improves drainage. Specific exercises will be recommended by your doctor and/or physical therapist.

• Bandage. Wearing a customized compression sleeve or elastic bandage may help to prevent an accumulation of fluid.

• Arm pump. Applying an arm pump often helps to increase the fluid flow in the lymphatic vessels and keeps the fluid from collecting in the arm.

• Diet. Eating a well-balanced diet and controlling body weight is an important part of treatment.

• Keep the arm raised. Keeping the arm raised above the level of the heart, whenever possible, allows gravity to help drain the accumulated fluid.

• Prevent infection. It is important to follow preventive measures, such as good skin care, to protect the affected arm from infection and skin breakdown.

Breast cancer patients who perform good skin care and exercise properly after mastectomy are less likely to develop lymphedema.

Preventing and controlling lymphedema

Protection of the arm on the side of the surgery is very important after breast surgery. Poor drainage of the lymphatic system may cause that arm to be more susceptible to infection and less sensitive to extreme temperatures. People who have had surgery to remove lymph nodes in the arm pit should be aware of those activities that put too much pressure on the affected arm. Protective measures to avoid injury and infection include:

• Make sure that all injections are given and blood tests are drawn in the unaffected arm.

• Do not wear nightgowns or clothing with elastic cuffs.

• Carry your handbag or heavy packages in the unaffected arm.

• Use an electric shaver when shaving underarms.

• Avoid sunburns and other burns to the affected arm.

• If at all possible, have all blood pressure tests done on the unaffected arm.

• Wear gloves when gardening and when using strong household detergents.

• Clean the skin of the affected arm daily and apply lotion. When drying the arm, be gentle, but thorough.

• Keep the arm elevated when possible.

• Do exercises regularly to improve drainage, but first consult with your doctor or physical therapist.

• Eat a well-balanced, low-sodium diet.

• Avoid extreme hot or cold temperatures on the affected arm, such as heating pads or ice packs.

• Take proper care of the fingernails and avoid cutting 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 the affected arm.

• Notify your doctor immediately of any signs of infection, such as redness, pain, heat, increased swelling, or fever.

Talk with your doctor about what you can do to try to prevent lymphedema from happening to you. If lymphedema does develop, let your doctor know right away. There are things you can do to try to keep it from getting worse.