Lymphatics and Arm Swelling after Mastectomy
BreastCancer.org states “lymphedema is caused by a buildup of lymph, which is a thin, clear fluid that circulates throughout the body to remove wastes and bacteria from the tissues”.
This buildup can occur in any area of the body, but it typically occurs in the arm, hand, breast, or torso of patients who have undergone breast cancer surgery or radiation therapy. Lymphedema can occur months or years after surgery/treatment. Hopkins Medicine reports on three types of lymphedema that can develop below.
Types of Lymphedema
A mild type of lymphedema can occur within a few days after surgery and usually lasts a short time.
Lymphedema can also occur about 4 to 6 weeks after surgery or radiation and then goes away over time.
The most common type of lymphedema is painless and may slowly develop 18 to 24 months or more after surgery. It does not get better without treatment.
Many people with breast cancer have at least two or three lymph nodes removed from under the arm (sentinel lymph node biopsy), and sometimes many more nodes (axillary lymph node dissection) may get removed.
If the cancer has spread (metastasized), it would most likely move into the underarm lymph nodes first because they drain lymph from the breast.
Many people also need radiation therapy to the chest area and/or underarm. Surgery and radiation can cut off or damage some of the nodes and vessels that the lymph moves through. Over time, the flow of lymph can overwhelm the intact remaining pathways. This can result in a backup of fluid into the body’s tissues. Hopkins Medicine describes the symptoms of lymphedema below.
Symptoms of Lymphedema
Feeling of fullness, heaviness, or tightness in the arm, chest, or armpit area
Bra, clothing, or jewellery doesn't fit as normal
Aching or new pain in the arm
Trouble bending or moving a joint, such as the fingers, wrist, elbow, or shoulder
Swelling in the hand
Thickening of or changes in the skin
Weakness in the arm
Not every patient who undergoes surgery or radiation therapy will develop lymphedema. However, Hopkins Medicine describes a few risk factors that may cause a patient to be at a greater risk for the development of this condition.
Lymphedema Risk Factors
Having more lymph nodes removed
Having multiple surgeries to the chest
Radiation therapy
Chemotherapy
Being overweight or obese
Infection or injury to the arm, hand, or upper body on the same side as the surgery took place
Women treated for breast cancer who have good skin care and who exercise after treatment are less likely to develop lymphedema. Newer types of lymph node surgery have also helped decrease lymphedema risk. But there is no sure way to prevent lymphedema. Hopkins Medicine lists the following as some helpful and effective treatments for lymphedema.
Treatment for Lymphedema
Exercise. Exercise helps improve lymph drainage. Specific exercises will be advised by your doctor or physical therapist.
Bandages. Wearing a compression sleeve or elastic bandage may help to move fluid, and prevent the buildup of fluid.
Diet and weight management. Eating a healthy diet and controlling body weight is an important part of treatment.
Keeping the arm raised. Raising the arm above the level of the heart when possible lets gravity help drain the fluid.
Preventing infection. It’s important to protect the skin in the affected area from drying, cracking, infection and skin breakdown. Your healthcare provider will advise you about how to care for your skin and nails to help prevent problems.
Massage therapy. Getting a massage from someone trained in lymphedema treatment can help move fluid out of the swollen area.
The creation of an exercise plan with your Physiotherapist will typically include gentle stretching exercises, strength training, and aerobic exercises. Relaxation techniques such as deep breathing will also aid in helping move the lymph along.
It is important that your oncologist or family doctor approve the commencement of an exercise plan, and provide each of their patients with activities that are safe to complete and ones that are to be avoided. This will be important information for your Physiotherapist at your initial appointment, so make sure these recommendations are brought with you.
References