Many women worry about the possibility of developing lymhedema after breast cancer surgery. Although the risk is smaller for women who have had a sentinel node biopsy (rather than a larger axillary node dissection), it is still there. Receiving radiation therapy, especially to the axillary area, makes the risk larger.
Here is more information from an article in Cancer Net:
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After Treatment for Breast Cancer: Preventing Lymphedema
Listen to the Cancer.Net Podcast: After Breast Cancer: Preventing Lymphedema, adapted from this feature.
Most women diagnosed with breast cancer need to have some type of surgery during treatment. The reasons for surgery can vary and may include removing the cancerous tumor and surrounding breast tissue (lumpectomy or mastectomy), evaluating whether the disease has spread to the lymph nodes under the arm (sentinel lymph node biopsy or axillary lymph node dissection), or reconstructing the chest to restore a more natural appearance. Any intervention (radiation therapy or surgery) that disrupts the drainage of the lymph nodes under the arm increases the risk of lymphedema.
Lymphedema is an abnormal buildup of fluid (lymph fluid) that causes swelling, usually in the arms and legs. Lymph is the fluid that carries immune cells (mostly lymphocytes) throughout the body. It is similar to a "highway" for your immune system. Lymph nodes are tiny, bean-shaped organs that fight infection. They can be compared to "rest stops" for your immune cells. Axillary lymph nodes are located underneath the arm.
When the lymph nodes are removed, there is a backup of lymph into the surrounding tissues (because the "rest stops" are gone). This is called lymphedema. There is always a risk of developing lymphedema when lymph nodes are removed. This risk is the same whether lymph nodes are removed under the arm (as in breast cancer surgery) or any other part of the body (for example, people with melanoma).
Types of lymphedema
Lymphedema can be primary or secondary. Primary lymphedema can be present at birth, develop at the onset of puberty, or occur in adulthood from unknown causes or from vascular abnormalities. Secondary lymphedema can be caused by any process that disrupts the drainage of the lymphatic channels, including infection, trauma, surgery, or radiation therapy. This article refers to secondary lymphedema caused by surgery and/or radiation therapy for breast cancer.
Breast surgery and lymphedema
Lymphedema occurs in about 15% of women who undergo mastectomy with removal of all the lymph nodes under the arm. Women who have had the following procedures may also be at risk for developing lymphedema in the arms and hands:
- A lumpectomy in combination with axillary lymph node removal
- Radiation therapy to the underarm area after surgical removal of axillary lymph nodes
All of these procedures disrupt the normal lymphatic drainage from the arm to the rest of the body.
The development of lymphedema is often subtle and may first appear as a feeling of tightness around the shoulder, arm, or hand. A woman may also notice a decreased flexibility in the arm, wrist, or hand, or a heavy sensation in the arm.
The condition may develop within a few days, months, or even years after surgery. In extreme cases, the lymphedema can extend from the hand through the entire arm to include the chest wall. A woman should talk with her doctor if she suspects she has lymphedema. Although it's not possible to predict who will develop lymphedema, a woman can take steps to reduce her risk.
- A week after surgery and/or radiation therapy, begin daily stretching exercises as directed by your doctor or nurse. Continue these exercises up to 18 months after surgery and treatment to maintain your range of motion.
- Avoid alcoholic beverages.
- Exercise regularly. Be sure to check with the doctor before starting or resuming an exercise program. If your normal fitness regimen included using arm weights, ask the doctor how long you should wait before resuming this activity and whether he or she recommends any weight restrictions.
- Lighten your purse and try not to carry it or heavy bags on the side where the surgery was performed.
- Try not to carry young children in order to avoid arm strain.
A sudden increase in the amount of physical work performed with the arm on the surgery side can increase the risk of lymphedema (for example, packing up your house for a move)
More on exercising with lymphedema
To improve cardiovascular fitness, perform aerobic activities such as walking, swimming, or participating in low-impact aerobics for 20 to 30 minutes a day, three times a week. Gradually increase the intensity and duration of the exercise. Be sure to include a five-minute, warm-up routine such as stretching exercises before beginning a fitness program and a five-minute to 10-minute cool down period after an aerobic activity.
Stop exercising at the first sign of pain. If your arm on the side where you had the surgery becomes tired during exercise, cool down and elevate it.
When more lymph nodes are removed during breast cancer surgery, the risk of developing lymphedema and infections increases. This is because the lymph nodes help keep the immune system functioning properly by filtering harmful, foreign substances such as bacteria from the lymph fluid.
Below are steps women can take to avoid infections.
- Wear gloves while doing housework or gardening.
- Avoid having cuticles cut when getting a manicure.
- Wash your hands with soap and warm water frequently, especially before preparing food and after using the bathroom or touching soiled linens or clothes.
- Protect the skin from scratches, sores, burns (including sunburn), and other problems that might cause infection.
- Use insect repellents to prevent bug bites.
- Apply moisturizer daily to prevent skin chapping.
- Avoid needle sticks of any type in the affected arm.
- Use thimbles when sewing.
- Use an electric shaver to remove underarm hair, as it may be less likely to cut or break the skin then other razors or hair removal methods.
Call the doctor at the first sign of infection. In addition to fevers and chills, other signs and symptoms that you should watch for on the arm or hand on the same side as the surgery include:
- Rash or red blotches
- Pain, tenderness, redness, or swelling
- Wound or cut that won't heal
- Red, warm, or draining sore
There is no cure for lymphedema, which makes proper care and treatment of the affected arm even more important. Ask the doctor to recommend an occupational therapist who specializes in managing lymphedema. The therapist can assess your condition and develop a treatment plan, which may include specific exercises, limitation of certain activities that are too vigorous or repetitive, and recommendations for complete decongestive therapy consisting of a compression sleeve, bandaging, manual lymph drainage, education in self-care, and possibly a drainage pump.
Other ways to manage lymphedema
Avoid extreme temperature changes. For example, don't use hot tubs, whirlpools, saunas, or steam baths. Use warm instead of very hot water when bathing or washing dishes. To prevent sunburn and skin breakdown, always wear sunscreen (at least sun protection factor, or SPF, 15) or cover the arm completely when outdoors, or stay out of the sun altogether, particularly during the hottest part of the day.
Avoid blood pressure readings in the affected arm.
When traveling by air, ask the doctor if you should wear a compression sleeve on the affected arm. If possible, keep the arm elevated (above the level of your heart) and flex it frequently during the trip.
When sitting or sleeping, elevate the arm on a pillow and avoid lying on the affected side for an extended time.
Managing Side Effects: Fluid in the Arms or Legs or Lymphedema
Cancer.Net Feature: After a Mastectomy: What to Know
The National Lymphedema Network
American Cancer Society: Understanding Lymphedema
Lance Armstrong Foundation: Lymphedema