Lymphedema Risk and Compression Sleeves

People who have had surgery that includes the removal of lymph nodes are at some risk, of varying levels, of developing lymphedema. Lymphedema is the build-up or collection of lymph fluid in soft body tissues that can occur when the usual flow is interrupted. For cancer patients, this generally happens in two situations. The more common one is women who have had breast cancer surgery that included a full axillary dissection, and, therefore, the removal of more lymph nodes than happens in a sentinel node dissection, when only one or maybe two nodes are taken.

The finding was that the prophylactic wearing of compression sleeves reduced the incidence of arm swelling.

The second scenario can happen with melanoma surgery which may also include nodal dissection. Depending on the location of the surgery, the involved nodes may be in the groin. In this instance, lymphedema can occur in the lower extremity on the affected side. Lymphedema less often can occur on the chest wall, abdomen, neck, or genitals.

The lymph system is a network of lymph vessels, tissues, and organs that carry lymph everywhere in the body. Their purpose is to help fight infection. Think of a clogged sink, and you have a good understanding of lymphedema. If the natural flow is disturbed, everything backs up and can result in discomfort and swelling. There are treatments for lymphedema, including compression sleeves, massage, exercises, and sometimes a pneumatic pump. Recently there have been surgeries developed to treat severe lymphedema; the Boston Lymphatic Center at BIDMC offers information and treatment for this condition.

The focus of this article and the goal of care in general is to avoid lymphedema. Once it has happened, it can be treated, but it rarely can be fully cured. You can read more about lymphedema prevention and treatment here.

A recent article in The Journal of Clinical Oncology reported on the results of a randomized controlled trial for women at high risk of breast cancer-related lymphedema. Women at high risk are those who have had a fully axillary dissection and radiation therapy. Although lymphedema can happen anytime, even years after surgery, we know that any arm swelling in the first year is a predictive factor for future trouble. This trial studied whether the use of arm compression sleeves during the first year would reduce the incidence of swelling and, therefore, the development of lymphedema.

More than 300 women were randomly assigned to either the compression sleeve-wearing group or the control group. Those in the first group were given two compression sleeves to wear from the time of surgery until three months after completing adjuvant treatment. The finding was that the prophylactic wearing of compression sleeves reduced the incidence of arm swelling without negatively affecting quality of life or symptoms (the italics are mine).

My use of italics is to reflect my thoughts about this conclusion. Of course, it is preferable to avoid lymphedema, but I doubt that any woman who has worn a compression sleeve would agree that there are no negative consequences. First, they can be hot and uncomfortable. Second, they can be embarrassing, or awkward and a cause of uncomfortable feelings. I have known many women wearing sleeves who were asked by strangers: What’s wrong with your arm? This may not be a problem for some, but, for others, it is difficult. Do you want to share information about a breast cancer diagnosis with strangers, or do you feel the need to invent some other reason?

I think the take-home thought here is this is one more thing to consider during the early days of a breast cancer diagnosis. Depending on your risk and your worries, you might talk with your doctor about the wisdom of wearing a sleeve for the first year. If you choose to do so, there are also alternatives to the basic beige ones you can try.