Is Lymphedema a Risk After Breast Cancer Treatment?
One of the complications that can develop after breast cancer surgery is lymphedema. The good news? It’s very treatable.
Your entire body is lined with a series of vessels, nodes, and organs that collectively make up your lymphatic system, which helps your body fight off infections and keep fluids balanced in your body. Parts of that system may be damaged or removed during breast cancer treatments, leading to swelling, pain and other complications. A multidisciplinary team of experts from Sylvester Comprehensive Cancer Center and the University of Miami Health System can help you manage and minimize these complications.
Two years ago, the University of Miami Lymphatic Program, which brings together experts in breast cancer, lymphedema, physical therapy, rehabilitation, and plastic surgery, was created.
Ady Marie Correa Mendoza, M.D., who specializes in physical medicine and rehabilitation, Annemay Lelis, DPT, who manages the physical and occupational therapy team and Mark Lin, APRN, who is part of the plastic surgery team offered their thoughts what breast cancer survivors need to know about lymphedema.
What should breast cancer survivors know about the risk of lymphedema, and what can they do to protect themselves?
Lelis: Let me explain how lymphedema can happen so you understand how to prevent it. I like to give the analogy of a highway with toll booths, and traffic is flowing nicely as everything is working accordingly. The highways are the lymphatic vessels that carry lymph fluid, and the toll booths are the lymph nodes, where fluid is filtered out.
Lymphedema occurs when there is a problem with this system. When lymph nodes are removed from surgery, you now have fewer “toll booths” to help filter out the fluid, causing a buildup. If there is a highway blockage due to radiation therapy, it can cause a road to close, and this can also cause congestion and prevent lymph fluid from flowing.
So, lymphedema is like having a highway system where either the roads are blocked or the toll booths aren’t working correctly, causing a traffic jam of lymph fluid that results in swelling. The system still works, but it is just slow in getting the job done.
Correa: The risk of developing lymphedema in breast cancer survivors varies widely, ranging from 5 to 70%. The highest risk of developing lymphedema occurs within the first couple of years post-surgery. Risk factors associated with lymphedema include a higher number of lymph nodes removed, radiation therapy and some chemotherapies. Additionally, obesity and infections may increase the risk of lymphedema.
Lin: There are several things you can do to reduce your risk for lymphedema. During the mastectomy procedure, the plastic surgeon may be able to perform a risk-reducing lympho-venous bypass that can reduce the risk of developing lymphedema. Following mastectomies, you should wear a compression sleeve on the affected arm as much as possible, especially when you are exercising, doing any house chores or flying in an airplane. Other ways you can protect against lymphedema are through a healthy, balanced diet, exercise and skin care.
Keep your affected arm moisturized. Dry skin on the affected arm may lead to openings on the skin, which could cause a skin infection called cellulitis and trigger the lymphedema.
Correa: Wear long sleeves or apply sunblock if you are going to be exposed to the sun.
Lin: You should also be referred to lymphedema therapy, where occupational and physical therapists perform manual lymphatic massages to promote the movement of lymphatic fluid out of the affected arm.
Lelis: Remember to give the arm time to process the whole thing. For example, if you are doing work that requires repetitive movements like computer work, lifting, household chores or yard work, make sure to listen to your body. It will tell you when you are getting tired when things are “off.” In that case, rest the arm for a little bit, maybe 20 minutes, before starting to work again. This rest allows the lymphatic system to catch up, process more lymph fluid, and clear up the traffic jam.
Patients who suffer from lymphedema are often concerned about their quality of life after surgery. What can they expect in the short-term and long-term?
Correa: Immediately after surgery (depending on the type of surgery), you may have some restrictions on moving your shoulder. This should only be for a few weeks to allow the surgical site to heal. Once you are cleared by your surgeon, you need to start range-of-motion exercises, gradual strength training, and scar tissue mobilization to avoid long-term limitations in shoulder mobility.
You may have some swelling in the surgical site during the first few weeks after surgery. Continue to monitor yourself for any symptoms of lymphedema, including hand, arm, or trunk heaviness, puffiness or swelling or jewelry feeling tight. If you develop any symptoms of lymphedema, please report these to your doctors so you can be referred for lymphedema screening and start early treatments. When lymphedema is treated in its early stages, the risk of complications is significantly reduced, and you will be able to participate in most of the regular activities you used to perform before surgery.
Every patient is different, but what are some common exercises they should do when recovering from surgeries related to lymphedema or breast cancer?
Lelis: Exercise is super important for recovery and managing lymphedema. Here are some simple exercises that can help:
- Deep Breathing: Start with deep breathing exercises to get your lymphatic system moving. Sit comfortably, take a deep breath in through your nose, hold it for a few seconds, and then slowly exhale through your mouth.
- Shoulder Rolls: Gently roll your shoulders forward and backward. This helps keep your shoulders mobile and eases tension.
- Trunk mobility: Lay on your side with your knees bent. Bend your top arm and place it by your ear. Slowly rotate your upper body toward the ceiling. Your head and top arm should follow the movement, and your chest should open toward the ceiling.
- Arm Lifts: Lie on your back or sit down, then raise your arms above your head and slowly lower them. This can help with your range of motion and lymphatic drainage.
- Elbow Bends: Bend and straighten your elbows to keep your arms moving. You can do this with or without light weights, depending on what feels right for you.
- Wrist and Hand Exercises: Open and close your hands, make gentle fists, and rotate your wrists. These simple exercises are great for maintaining mobility.
Remember, everyone’s journey is unique, so listen to your body and always check in with your health care team for personalized advice. Our goal is to not have survivors fearful of movement, exercise, or just living life because of fear of lymphedema. The best thing you can do is to optimize your health and physical activity with a little bit of TLC to your arm.
Many patients who undergo breast cancer and lymphedema surgeries are concerned about how they’ll look afterward, so what can you tell them about the state of plastic surgery related to those procedures?
Lin: Patients who undergo mastectomies to treat breast cancer are generally offered three forms of reconstruction; they may stay flat following the mastectomies and wear their scar with pride, they may undergo breast reconstruction with implants, or they may undergo breast reconstruction with tissue from another part of the body. Patients who opt to stay flat following the mastectomies may also request mastectomy bras with external silicone and foam implants.
In terms of lymphatic reconstruction, there are two surgeries that are done to help you manage lymphedema.
One of the surgical options is called a lymphovenous bypass. The plastic surgeon will cut the lymphatic channel and connect it to a vein using the help of an operating microscope in the operating room. This bypasses the lymphatic channels and allows lymphatic fluid to be drained into a vein. Going back to Lelis’ highway metaphor, the lymphovenous bypass is essentially opening another exit on a highway that has a lot of traffic to allow the lymphatic fluid to move.
Another surgical option that is offered is called a lymph node transfer. The surgeon takes a healthy lymph node from another part of your body and put it in the affected arm. Studies done by the Journal of the American Society of Plastic Surgeons have shown by transferring this lymph node, it promotes the growth of new lymphatic channels in the area.
There is another surgical option that is offered to address the fatty tissue that is associated with lymphedema. Initially lymphedema is a fluid problem. Over time, the inflammation associated with lymphedema can lead to fatty tissue. At the University of Miami, we offer liposuction to remove the fat.
Learn more about lymphedema treatment options at UHealth.
Alan Gomez is a contributing writer for UHealth’s news service.
Tags: after treatment, breast cancer and lymphedema, lymph fluid, lymphedema
