Lymphedema after breast cancer surgery and home interventions
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
SEPTEMBER 05, 2019
Be forewarned: this is another discouraging piece about lymphedema. The truth remains that some women develop lymphedema after breast surgery; the statistics are all over the place, ranging from 3% after wide excision/lumpectomy alone to 70% after a modified radical mastectomy and radiation. It is agreed that women who have a full axillary dissection (as opposed to only a sentinel node removal) followed by radiation therapy are at most risk. And that is pretty much the end of the agreement.
Depending on what you read and whom you listen to, there are many or few suggestions about activities to avoid and other risk factors. For example, until quite recently, women were encouraged to wear a compression sleeve while flying, but an actual study found no difference in incidence of lymphedema between women who wore a sleeve and those who did not. Especially those of us who had a full axillary dissection need to be aware of the risks of infection. Again, you can read really scary things that tell you to avoid manicures and hot tubs, and others that merely advise you to wear gloves when gardening and apply antibiotic ointment to any cut on the affected side.
Lymphedema happens when surgery causes a change in the way lymph fluid drains. The shift towards sentinel node biopsies instead of full axillary dissections when possible has reduced, but not eliminated, the risk. Removing lymph nodes as part of breast cancer surgery clearly changes the body's usual drainage system. If the fluid cannot drain per usual, it can build up and cause swelling of the breast, hand, arm, or even torso on the side of the surgery. Lymphedema can also be quite uncomfortable and unsightly.
A recent study found that commonly recommended home-based interventions, including weight loss and exercise, did not reduce the incidence of lymphedema or decrease arm swelling or improve any symptoms. These findings contradicted an earlier observational study that indicated that weight loss might help. However, a second study did not validate this finding.
This leaves us with limited options, and the unhappy reality that lymphedema is impossible to predict and impossible to fully cure. Once it has happened, the goal is usually to minimize it as much as possible and prevent increased swelling. The usual treatments include PT, massage, pressure sleeves and gloves, and arm wrapping. There are new surgical techniques that can help improve lymphatic drainage and reduce arm swelling; I have known a few women who were greatly helped by these procedures. Read about the lymphedema center and this surgery at BIDMC.
My observation has been that many women worry about lymphedema after breast surgery, and wish there were more things we could do to minimize our risk. Learning now that the recommendations about weight loss and exercise don't help is distressing. Let us, however, remember that is generally good advice, and we can contribute to our odds of staying healthy by generally taking care of ourselves. Losing the possible additional benefit of reducing lymphedema does not mean that we should ignore the practical advice.