All of us have some level of concern about lymphedema, and many of us worry more than we probably need to. No one really knows the incidence of lymphedema after breast cancer, but we are fairly clear about the factors that increase risk: full axillary dissection and radiation. If you look at the website of the National Lymphedema Network, there is a lot of information and a long list of precautions (which don't guarantee it won't ever happen).
There is particular controversy about the recommendation of wearing a pressure sleeve when you fly. Several recent studies have concluded that it is unnecessary, but some experts continue to believe it a wise behavior. (Full disclosure: I spend a fair amount of time on airplanes, and have taken a number of 15+ hour flights and never wear a sleeve.) I have known only one woman who developed lymphedema after a flight, and she flew to Seattle non-stop about two weeks after her surgery. I always have assumed the problem there was the timing.
The reason that lymphedema is a genuine problem is that, once you have it, it never goes completely away. There are a number of time-consuming treatments involving wearing pressure sleeves and, sometimes, gloves, massage from a PT, using machines that massage and hopefully move the fluid. It can be uncomfortable and unsightly, and surely all of us hope to avoid it.
Here is an excellent summary from ASCO's Cancer Net:
After Treatment for Breast Cancer: Preventing Lymphedemaymphedema
Lymphedema is an abnormal buildup of fluid (lymph) that causes swelling, usually in the arms and legs. Lymph is the fluid that carries immune cells (mostly lymphocytes) and proteins found in the blood 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. Sometimes they are also referred to as filters. Any treatment-such as radiation therapy or surgery-that stops or slows the drainage of the lymph nodes under the arm increases the risk of lymphedema. This article discusses lymphedema caused by surgery and/or radiation therapy for breast cancer.
Lymphedema in the arms and hands occurs in about 5% to 40% of women who have had a mastectomy with removal of all the axillary (underarm) lymph nodes. This range is large because experts don't always agree on how to define lymphedema, and it can be difficult to measure. Women who have had the following procedures may also be at risk for developing lymphedema:
- A lumpectomy with an axillary lymph node removal or a sentinel lymph node biopsy (removal of a few lymph nodes to check for evidence of cancer)
- Radiation therapy to the underarm area after surgical removal or biopsy of the axillary lymph nodes
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