• Evolution Physical Therapy

Lymphedema Management

by Jennifer Unterreiner, DPT, OCS, CLT (Certified Lymphedema Therapist)

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One of the most common concerns women typically have following their mastectomy or lumpectomy is regarding their risk of developing lymphedema, or swelling caused by extra fluid buildup after the damage or removal of lymph nodes. Unfortunately, we, as a medical community, don’t have answers or guidelines for knowing who will or won't develop it following lymph node removal. Despite it often being a side effect of cancer treatment, there is no "magic number" of lymph nodes that can be removed that guarantees either way whether or not the swelling will occur. However, we do believe that, when considered with the rest of your clinical case and medical history, the higher the number of lymph nodes removed does slightly increase your risk of developing lymphedema.

The job of the lymphatic system is to function as the garbage disposal system for the body, carrying out cell waste, metabolic byproducts and protein waste from the local tissue into the bigger vessels to be excreted. The problem is that when lymph nodes are removed, the same volume of fluid still needs to be processed and filtered, but there are fewer nodes to do the job. When combined with local scarring and inflammation, the lymphatic system can easily become overwhelmed, resulting in back-logging of the fluid into the rest of the arm or breast. The good news is that there is a lot of redundancy built into the lymphatic system already, with complex network connections linking the different layers of the system and 35-40 lymph nodes present in each armpit to be able to support and filter the lymphatic fluid that circulates through your body normally each day.

Previously, we believed that patients at risk for lymphedema should wear a compression sleeve while flying, but recent research has determined that is not necessary - though many patients elect to still do so for peace of mind. We also instructed patients on the at-risk side to avoid taking blood pressure and to avoid injections or blood draws from that limb. While the blood pressure guideline is not as accurate or strictly enforced, most patients elect to follow that precaution out of comfort. Avoiding injections or blood draws from the at-risk side is recommended in order to avoid any possible wound or site for bacteria to enter the system and potentially cause other problems.

There are a few things you can do to help decrease your risk of developing lymphedema. These include:

  • Participating in regular exercise: this helps maintain healthy stress on the system that allows it to keep functioning at an optimum level

  • Maintaining a healthy body weight and BMI: this acts to minimize excessive stress and increased volume on your lymphatic system

  • Maintain good skin health: by avoiding skin cracking, peeling, blistering or dryness, you're able to provide an additional barrier to any bacteria and prevent the development of an overload response to a possible infection

  • Use sunscreen and good moisturizers daily: this helps to provide the skin with additional support in order to minimize the risk of developing other skin issues

  • Keep any cuts/scrapes/wounds clean and protected until fully healed: by keeping these small cuts clean and protected, you can minimize risk of infection that could contribute to lymphedema development or bigger health issues

If deemed appropriate, or if lymphedema does develop, special types of massage intended to replicate the function of the lymphatic system can be done to re-route the swelling to other healthy parts of the system. This is typically followed up with the use of a special compression garment and/or compression bandaging to decrease the likelihood that the swelling returns to the arm or breast. As with any other diagnosis, the key to management is early intervention and awareness to prevent complications and provide complete education for self-management and care.

As part of a comprehensive treatment plan, it's advised that you meet with a certified lymphedema specialist in order to assess your risk, take circumferential measurements to provide a baseline and fit you for a compression sleeve (as appropriate), as well as answer any specific questions related to your unique circumstances and situation soon after your lymph node dissection.

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