If you have been diagnosed with breast cancer, there are undoubtedly questions swirling around your mind, such as treatment options, side effects, and follow-up care. What you may not be thinking about is lymphedema—an accumulation of fluid in the arm, breast, or chest wall that occurs as a result of a disruption in the natural drainage of lymph. Lymph is a colorless fluid that bathes tissues, and while it is a natural fluid, its accumulation is not and can be problematic.
It’s important to educate yourself about lymphedema. Here is what you should know:
Who is at risk for lymphedema?
- Anyone who has had a mastectomy or lumpectomy in combination with axillary lymph node surgery (a procedure used to examine or remove lymph nodes, such as a sentinel node biopsy or axillary dissection) is at risk. The risk is 1-2% with sentinel node biopsy and 10-30% with axillary node dissection plus/minus radiation. Lymphedema can occur immediately after surgery, within a few months or years, or sometimes many years after cancer therapy. The highest risk is in the first three years, but the overall risk is lifelong. In advance of your surgery, is important that you understand the procedure you have planned and why, and make sure you discuss with your care team how many nodes were removed in total after your surgery.
- Treatments such as radiation therapy also increase your risk, including axillary radiation or radiation to the lymph nodes. Be sure to discuss with your radiation oncologist the total dose going to your axilla and how it might impact your risk of developing lymphedema.
- Other risk factors include Taxane-based chemotherapy (paclitaxel, docetaxel ), symptomatic seromas, and multiple breast surgeries. The more lymph nodes removed in combination with increased trauma to the axilla increases your overall risk of lymphedema.
- Some modifiable risk factors increase your risk of lymphedema, such as obesity, smoking, sedentary behavior, and poor shoulder range of motion. Lifestyle changes are beneficial to reduce your overall risk of lymphedema and these benefits extend throughout your lifetime.
What can I do to help lower my risk of getting lymphedema?
If you are at risk, there are many prevention strategies that can help to reduce your chances of getting lymphedema.
- Keep your skin, nails, and cuticles clean and moisturized to avoid skin cracking.
- Try to avoid cuts and scrapes in the affected limb by wearing long sleeves or gloves while doing activities such as yardwork. Use antibiotic cream and cover any open wounds with a Band-Aid to reduce the risk of infection.
- Wear SPF 30 sunscreen daily.
- Exercise: Incorporate mobility exercises, strengthening, and cardiovascular exercises into your life.
- Good posture, strong muscles, and mobility improves lymphatic flow.
- Slow and progressive strengthening exercises have been shown to reduce your risk of lymphedema.
- Ask for a referral to physical or occupational therapy if you have reduced arm range of motion, which can reduce lymphatic flow.
- Achieve or maintain a healthy body weight and body composition levels.
- Reduce or eliminate smoking (tobacco and vaping).
- At the time of surgery, speak with your surgeon about a referral to a physical therapist or occupational therapist, as these specialists can help prevent or identify lymphedema at its earliest stages.
- Contact your surgeon or oncologist immediately if you have unusual swelling, pain, heaviness, or tightness in your clothes or jewelry.
Frequently asked questions for people at risk of lymphedema:
Do I need to be fitted for a compression garment?
Not unless you have signs of active lymphedema. You will be referred to a specialist for proper fitting and recommendations.
Is it safe to have my blood pressure taken on the same side that I had a lumpectomy or mastectomy?
Yes. While many patients feel more comfortable having their blood pressure taken on the non-affected limb, this is not necessary. It is also not necessary to have blood pressure taken manually.
Is it safe to get a flu shot or have blood taken on the same side as my lumpectomy or mastectomy?
Yes. Sterile needle sticks are safe. While many patients feel more comfortable on the non-surgical arm, this is not necessary.
Do I need to wear a compression garment when exercising, walking the dog, gardening, or going to the grocery store?
No. Start exercising slowly as directed by your medical team, who will provide appropriate postsurgical recommendations. Then, progress slowly with all physical activity including exercises such as lifting weights or activities such as house or yard work in the first few months after surgery. It is not necessary to avoid physical tasks. It is recommended to progress your time, intensity, and duration of physical activity in moderation and strive to reach a lifestyle of consistent exercise to reduce your risk of lymphedema throughout your lifetime. If you notice symptoms, contact your medical team.
Is it safe to fly in an airplane or take a road trip?
Yes. It is strongly recommended that you get help when carrying heavy bags, lifting baggage overhead, and performing new or more challenging tasks to avoid trauma to your arm. Use wheeled luggage and check your bags when you are able.
Do I need to wear a compression garment when flying or on road trips?
No. During travel it is important to keep active and maintain good posture to assist the lymphatic system. Keep your lymphatic system active by making a fist or pumping your hands while elevated above the heart. Take your arms through their full range of motion and take walks in the airport or at rest stops as you are able.
Lymphedema can be life altering, and it is important to understand the facts. The best treatment for lymphedema is early treatment, so be sure to talk with your care team about your individual risks, best options, and if they can connect you with a certified therapist.