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Vascular Disorders, and Soft Tissue Injuries
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During breast cancer surgery (mastectomy or lumpectomy), some of the lymph nodes in the underarm (called axillary lymph nodes) may be removed. They are checked to see if cancer cells are present. When axillary lymph nodes are removed (called axillary surgery) during breast surgery or are affected by radiation therapy, some of the vessels that carry lymph fluid can become blocked. This may prevent lymph fluid from leaving the area.
Lymphedema (LIMF-eh-DEE-ma) occurs when lymph fluid collects in the arm (or other area such as the hand, fingers, chest or back) causing it to swell (edema).
The swelling may be so slight you barely notice it or so great your arm grows very large. In severe cases, lymphedema can cause pain and limit movement. And, the look of the affected arm can be upsetting. For a picture of lymphedema, visit the Society for Vascular Surgery website.
Lymphedema is related to axillary surgery and radiation therapy, but it is not
clear why some breast cancer survivors
get lymphedema and others do not. Some factors that increase risk include]:
• Removal of a large number of axillary lymph nodes during surgery
• Radiation to the axillary area
• A combination of axillary surgery and radiation to the axillary lymph nodes
• Having a large number of axillary lymph nodes that contain cancer
• Infections in the area after breast surgery
• Being overweight
How often does lymphedema occur (axillary dissection versus sentinel node
biopsy)?
Fortunately, most breast cancer survivors don’t get lymphedema. And, since modern surgery removes
fewer axillary lymph
nodes:
• Lymphedema is less common now than in the past
• The cases that do occur are less severe in terms of the impact on movement
and the way the arm looks
In the past, people almost always had a procedure called axillary dissection to remove axillary lymph nodes. Now, most people have a less-invasive procedure called sentinel node biopsy. This procedure removes fewer lymph nodes than axillary dissection, so there is less risk of lymphedema]. Breast cancer survivors who have an axillary dissection are about three times more likely to develop lymphedema than those who have sentinel node biopsy. Some findings show that one year after breast surgery, fewer than five percent of breast cancer survivors who had sentinel node biopsy had lymphedema compared to 10 to 20 percent of women who had axillary dissection.
For women who choose breast reconstruction after a mastectomy, the type of reconstruction does not seem to impact the risk of lymphedema]
Lymphedema usually develops within three years of breast surgery. It may occur immediately after surgery or many years after treatment [75].
If you notice early signs of lymphedema, talk to your health care provider. Although there is no cure
for lymphedema,
when it is caught early, treatment can reduce some symptoms and stop them from getting worse. Signs
of lymphedema may
include:
• Swelling in the arm or hand (for example, you may notice a tighter fit of rings or watches)
• Feeling of tightness, heaviness or fullness in the arm or hand
• Feeling of tightness in the skin or a thickening of the skin
• Pain or redness in the arm or hand
Although there is no cure for lymphedema, treatment can improve movement and reduce pain and swelling in the affected arm.
Standard lymphedema treatment includes complex decongestive therapy. This approach aims to decrease
swelling and
infection related to lymphedema through a combination of:
• Skin and nail care
• Compression bandages or sleeves (these apply pressure around the arm and
help push lymph fluid out of the arm)
• Exercises (closing and opening a fist, for example)
• Manual lymphatic drainage (a special type of massage)
• Physical therapy
• Exercise
• Compression device (a pump connected to a sleeve that inflates and deflates
to apply pressure to the arm)
• Surgery
• Weight loss
Before starting any of these therapies, discuss them with your health care provider. Many therapies are done by a physical therapist. Your provider may recommend a physical therapist or you can find one through the National Lymphedema Network or the Lymphology Association of North America.
• Treat infections of the at-risk arm and
hand right away.
• Wear gloves when doing house or
garden work.
• Keep skin clean and well-moisturized.
• Use the arm not at risk when having
blood drawn, getting injections or
having blood pressure taken.
• Avoid sunburn and excess heat from
saunas, hot baths, tanning and other
sources.
• Do not cut nail cuticles.
• Use insect repellant when outdoors.
• Avoid injuries, including scratches and
bruises, to the at-risk arm.
• Rest the at-risk arm in an elevated
position (above the heart or shoulder).
If you have an infection, injury or any of the symptoms listed above, see your health care provider
In the past, there was some concern that exercise might increase the risk of lymphedema for breast cancer survivors and worsen symptoms in those who developed the condition.
Studies now show that after recovery from breast surgery, arm exercises (such as weight-lifting) do not appear to increase the risk of lymphedema in survivors. Moreover, studies now show weight-lifting (in a supervised research setting) can reduce symptoms in survivors with lymphedema, as well as improve body image, sexuality and physical strength. However, strenuous exercise should be avoided immediately after breast surgery.
Talk to your health care provider before starting an exercise program to manage lymphedema.
Although there is no proven way to prevent lymphedema, survivors can:
• Be aware that lymphedema is a
possible side effect of treatment.
• Seek care at the first sign of symptoms.
• Take steps to try to reduce the risk of
injury and infection.
Injury or infection to the arm may trigger lymphedema. So it is best to take steps to reduce the risk of injury or infection. Although the tips below have not been proven in clinical trials, they may work for some people.
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