Lymphedema is a condition affecting many breast cancer survivors. This can occur when lymph nodes are removed or radiated as part of cancer care, resulting in the buildup of lymphatic fluid. The symptoms can range from a subjective heaviness to massive swelling in the limb, as well as infection and skin changes. Early diagnosis and treatment are important to prevent lymphedema from progressing. Managing lymphedema includes manual decompressive massage, compression wraps, and compression garments. Surgical options include lymphatic reconstruction with lymph node transfer and lymphovenous bypass, debulking with liposuction, and direct excision.
Causes of Lymphedema
Lymphedema after breast cancer is known as secondary lymphedema. It is caused by damage to the body's lymphatic system during cancer treatments like surgery and radiation therapy. The lymphatic system is a network of lymph nodes, ducts, and vessels that help drain fluid from tissues and filter out waste and bacteria.
During breast cancer treatment, lymph nodes may be removed to check for cancer spread, which disrupts normal drainage routes. Radiation can also damage lymph nodes and vessels. With fewer or damaged lymph drainage pathways, fluid can back up and pool, causing swelling.
Sometimes, scarring from surgery or radiation can also cause blockages that prevent proper lymph drainage. An injury or infection in the affected area can also trigger the onset of lymphedema after cancer treatment. This condition can develop months or years after your initial cancer treatment.
Risk Factors
The more lymph nodes and vessels impacted by surgery and radiation, the higher the risk of developing lymphedema swelling and stiffness during cancer recovery. That is why it is important to monitor for and manage lymphedema early through techniques to encourage lymph drainage and reduce swelling.
Early detection, prompt treatment, and careful management of the at-risk area can help control lymphedema following breast cancer treatment. Here are the main risk factors for developing lymphedema:
- Extent of lymph node removal: Removing many lymph nodes or lymph node radiation increases your risk for lymphedema.
- Radiation therapy: Radiation can damage lymph nodes and vessels, limiting drainage.
- Surgery on the armpit area: More extensive surgery like axillary lymph node dissection increases risk compared to a lumpectomy.
- Obesity or high BMI can compromise your lymphatic function.
- Infection: Infections in the at-risk area can trigger lymphedema.
- Blood draws/IVs or blood pressure checks on the at-risk arm: Trauma from needles can cause swelling.
- Injury or trauma to the at-risk area
- Lack of exercise/immobility: Movement encourages lymph drainage.
- Genetics: Family history may increase susceptibility.
- Age: Older breast cancer survivors tend to have higher rates of lymphedema.
Diagnosis
If you notice swelling in your arms, breasts, or torso area after breast cancer treatment, let your doctor know right away - as this could be a sign of lymphedema. Your doctor will ask you some questions about when you first noticed the swelling, where exactly it Is located, whether you are having any pain or limited range of motion, and if there have been any changes to the appearance of the skin.
Next, they will thoroughly examine the swelling and compare it to an unaffected limb to identify differences in size or shape, pitting when they press the skin, thickening of tissues beneath the skin, and fluid buildup. Your doctor may also recommend additional imaging tests, such as:
- Lymphoscintigraphy: This uses a radioactive tracer to map your lymph drainage system, showing whether fluid is backing up.
- Ultrasound: This uses soundwaves to check for excess fluid pockets and tissue thickening.
- CT or MRI scan: This provides images of your lymph nodes and vessels to show abnormalities.
Your doctor may also track your arm measurements over multiple visits to document any swelling changes. By understanding your symptoms, examining your skin closely, reviewing your breast cancer treatment, and using imaging/scans, your doctor can confirm if you require treatment.
Treatment Options for Lymphedema
The specialists at The Breast Center of New Jersey have over 50 years of combined experience in the field of lymphedema. Our New Jersey-based care center offers the most comprehensive and customized treatment options for lymphedema in the state.
Non-Surgical Treatments
Compression Garments
Custom-fitted sleeves, stockings, bandages, or wearable devices that provide gentle pressure against the skin to limit fluid accumulation and encourage circulation back to the heart.
Manual Lymphatic Drainage (MLD)
A special type of gentle massage that follows lymph drainage pathways and stimulates flow by moving fluid from blocked areas into functioning vessels. Performed by lymphedema therapists.
Exercise/Movement
Certain exercises assist the natural pumping action of muscles to drain lymph fluid while preventing deconditioning.
Skin Care
Keeping the at-risk skin clean while avoiding cuts, injuries, constricting jewelry, or clothing protects damaged vessels and prevents infection.
Surgical Treatments
Lymphaticovenous Anastomosis (LVA):
Using microsurgery, the surgeon connects backed-up lymph vessels directly to small veins, allowing tissue fluid to empty out. LVA works best in earlier stages of lymphedema if intact lymph channels remain.
Free Lymph Node Transfer
Lymph node transfer takes healthy nodes from the neck, groin, or underarm and relocates them to the swollen area. The transferred nodes can improve drainage through the limb when combined with massage and movement. This technique helps with more advanced swelling.
Lymphedema Mass Excision
In severe cases, surgeons may remove damaged fatty/fibrous tissue in a mass excision. This invasive option usually is not recommended for arm lymphedema.
Liposuction
Removal of fatty tissue that can accumulate with lymphedema, allowing compression garments to fit better. This provides some swelling reduction.
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