Lymphedema Following a Mastectomy
The lymphatic system consists of many vessels that carry lymph (a clear, colorless fluid containing water and a few blood cells that originates in many organs and tissues) throughout the body. The lymphatic system helps to protect and maintain the fluid environment of the body by filtering and draining lymph away from each region of the body.
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 (also called the axillary lymph glands) 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 excess fluid, bacteria, and by-products of infections.
Whenever the normal drainage pattern in the lymph nodes is disturbed or damaged (often during surgery to remove the lymph nodes), swelling of the arm may occur. Radiation may also cause swelling of the arm. This swelling of the arm, caused by an abnormal collection of too much fluid, is called lymphedema.
When the lymph nodes under the arm have been removed, a woman is at higher risk of lymphedema. 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 4 to 6 weeks following surgery. However, the most common type of lymphedema is slow and painless and may occur 18 to 24 months after surgery.
There are no specific diagnostic tests for lymphedema. The physician 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 of the affected arm appear?)
- history of edema (severe swelling)
- current medications
- other medical conditions such as high blood pressure, heart disease, or diabetes
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
- 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 resemble other medical conditions. Consult a physician for a diagnosis.
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:
- Decongestive therapy
This therapy with a certified lymphedema therapist is the current international standard of care for managing lymphedema. It is non-invasive and based on the principles of patient and family centered care.
Exercise helps to restore flexibility and strength, and improves drainage. The type of exercises will be recommended by your physician and/or physical therapist.
Wearing a customized compression sleeve or elastic bandage may help to prevent an accumulation of fluid.
Eating a well-balanced, low-sodium diet and controlling body weight is an important part of treatment.
- Keep the arm raised
By keeping the arm raised above the level of the heart, when 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.
Protection of the swollen arm is very important after breast surgery. Poor drainage of the lymphatic system may cause the affected arm to be more susceptible to infection and to be less sensitive to extreme temperatures. Persons with lymphedema should avoid injury and infection and should be aware of those activities that put too much pressure on the affected arm. Protective measures include the following:
- Make sure that all injections are given and blood tests are drawn in the unaffected arm.
- Avoid wearing 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.
- Make sure that all blood pressure tests are performed 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 physician 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 anti-bacterial 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 physician immediately of any signs of infection, such as redness, pain, heat, increased swelling, or fever.