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Understanding Lymphedema after Breast Cancer Surgery

A breast cancer diagnosis can be overwhelming. In most cases, the first course of treatment will be surgery. The tumor will be removed surgically either by lumpectomy (removal of a portion of the breast) or mastectomy (removal of the breast). Determining the involvement of lymph nodes is an important part of the diagnostic process to determine the appropriate treatment.

“Lymph nodes and the lymphatic system are the unspoken heroes of the immune system,” said Matthew Greene, PT, CLT, a certified lymphedema therapist and manager of Cancer Rehab at the Asplundh Cancer Pavilion at Abington - Jefferson Health. “Their primary job is to drain fluid and excess protein from the cells. Then any sort of debris is disposed from the body through the venous system.” The lymph nodes are the hub of this system, deciding where fluid should be directed.

If lymph nodes are removed during breast surgery, the lymphatic system can usually manage normal flow with help from the remaining lymph nodes. However, the area will be more susceptible to lymphedema, a condition where fluid cannot properly drain from the surrounding tissue, causing swelling and increased risk of infection.

Understanding Lymphedema

Symptoms of lymphedema include heaviness, tightness, a feeling of pins and needles, shooting pains, or vague sensations in the limb that are hard to identify. Swelling is often the most pronounced symptom.

“In breast cancer patients, the condition appears in the arms, breasts or trunk, as lymph nodes in the area of the armpit are most commonly impacted,” said Greene. “These patients may notice symptoms on the back of the shoulder, down the arm, in the chest or on the ribcage.”

Number of Nodes Removed Plays a Role in Risk

Knowing your surgery and understanding your risk profile is the first step.

“Over the years, there have been significant improvements in breast cancer surgery,” said Greene. This includes sentinel lymph node biopsy (SLNB) for eligible patients. Using this method, the surgeon removes less than four nodes versus the more invasive axillary lymph node dissection (ALND) in which several more are removed.

According to the literature, approximately six percent of patients who receive SLNB surgery develop lymphedema, compared to approximately 20 percent of ALND patients.

“Your doctors and surgeon will recommend your best options, but being aware of your status is helpful when determining your risk of developing lymphedema,” said Greene.

5 Things to Do to Lower Your Risk of Being Affected by Lymphedema

  • Maintain a healthy lifestyle and weight before and after your surgery. Excess weight has been associated with a higher risk for developing lymphedema.
  • Maintain healthy skin both before and after surgery to avoid the cuts and scrapes that may cause the condition. Use an electric razor to shave, and wear gloves when gardening.
  • If you undergo ALND, wear non-constrictive clothing and jewelry; avoid blood pressure readings or needle sticks on the at-risk limb.
  • Gradually return to activities of daily living during the first two weeks after surgery. Progress to more strenuous activities when your surgeon advises. A careful progression will minimize risk until you have regained adequate strength and range of motion.
  • If you plan to travel by air and have undergone ALND, wear a compression garment while flying to account for changes in air pressure if you have significant risk of developing lymphedema. Consult with your physician or a lymphedema therapist to discuss your risk.

When counseling patients, Greene is careful to explain there is not a “silver bullet” for preventing lymphedema. The condition can appear even in those who have taken all the proper precautions. It may be useful to have your arms measured before and after surgery by either your physician or by a lymphedema therapist. This provides a benchmark if you suspect swelling.

“Lymphedema is manageable, but not curable. Keep an eye on your surveillance strategies and talk to your doctor,” said Greene.

To make an appointment with a lymphedema specialist, please call 215-481-2161.

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