Lymphedema Following a Mastectomy

What is the lymphatic system?

The lymphatic system consists of many vessels that carry lymph (a clear, colorless fluid containing water and a few blood cells that originates in many organs and tissues) throughout the body. The lymphatic system helps to protect and maintain the fluid environment of the body by filtering and draining lymph away from each region of the body.

Often during a lumpectomy or mastectomy, some or all of the lymph nodes under the arm may be removed. The lymph nodes under the arm (also called the axillary lymph glands) drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. The lymph nodes help to filter excess fluid, bacteria, and by-products of infections.

What is lymphedema?

Whenever the normal drainage pattern in the lymph nodes is disturbed or damaged (often during surgery to remove the lymph nodes), swelling of the arm may occur. Radiation may also cause swelling of the arm. This swelling of the arm, caused by an abnormal collection of too much fluid, is called lymphedema.

When the lymph nodes under the arm have been removed, a woman is at higher risk of lymphedema. Lymphedema may occur immediately following surgery, or months or years later. Not every woman who has a mastectomy will experience lymphedema.

There are several types of lymphedema. The acute, temporary, and mild type of lymphedema occurs within a few days after surgery and usually lasts a short period of time. The acute and more painful type of lymphedema can occur about 4 to 6 weeks following surgery. However, the most common type of lymphedema is slow and painless and may occur 18 to 24 months after surgery.

How is lymphedema diagnosed?

There are no specific diagnostic tests for lymphedema. The physician will complete a medical history and physical examination. The medical history may include questions regarding the following:

• past surgeries
• problems following the surgeries
• onset of symptoms (When did the swelling of the affected arm appear?)
• history of edema (severe swelling)
• current medications
• other medical conditions such as high blood pressure, heart disease, or diabetes

Treatment for lymphedema:

Treatment for lymphedema depends on the severity and extent of the condition. Prevention and controlling lymphedema play an important role with this condition since there is no cure.

Treatment may include the following:

• exercise Exercise helps to restore flexibility and strength, and improves drainage. The type of exercises will be recommended by your physician and/or physical therapist.
• bandage Wearing a customized compression sleeve or elastic bandage may help to prevent an accumulation of fluid.
• arm pump Applying an arm pump often helps to increase the fluid flow in the lymphatic vessels and keeps the fluid from collecting in the arm.
• diet Eating a well-balanced diet and controlling body weight is an important part of treatment.
• keep the arm raised By keeping the arm raised above the level of the heart, when possible, allows gravity to help drain the accumulated fluid.
• prevent infection It is important to follow preventive measures, such as good skin care, to protect the affected arm from infection and skin breakdown.

Breast cancer patients who perform good skin care and exercise properly after mastectomy are less likely to develop lymphedema.