What You Need To Know About Lymphedema:
A Frequent Problem Affiliated with Breast Cancer Treatment.
Table of Contents
- Anatomy & Physiology
- Lymphedema Vs. Edema
- Types of Treatment
- Manual Lymph Drainage
- Skin Care & Compression Bandaging
- Compression Garments
- Your Exercise Program
- Preventing or Minimizing the Effects of Lymphedma
- Living a Full Life
- Helpful Resources
Anatomy & Physiology
The Lymphatic system works in conjunction with the circulatory system by removing fluid, proteins, and toxins from the skin layers and subcutaneous tissues. These substances are routed by lymph nodes contained in the area of the head and neck, underarms, and groin. The lymph fluid flows through a series of capillaries just under the skin. The capillaries form a sort of “net” through the skin of the body. These capillaries connect to the lymph vessels commonly called lymphatices. The lymphatics are about the size of the blood veins but have thinner walls and are shorter in length. The lymphatics contain one-way valves which direct the flow of the lymph fluid toward the nodes. A lymph node serves as a filter, destroying potential toxins. The lymph nodes also produce antigens important to fighting off infection. Through a serves of lymph nodes and lymphatics, the lymph fluid finally rejoins the venous system where the fluid can be absorbed by the blood cells. The lymphatic system processes and returns 2 to 3 liters, or about 10%, of the fluid to the blood system everyday.
When the lymphatic system is overwhelmed, edema or swelling, occurs. The lymphatic system can be overwhelmed when the lymph system is compromised. This either occurs as a genetic defect, known as primary lymphedema, or as the result of trauma, surgery, lymph node removal, radiation, or infection, known as secondary lymphedema. We will concentrate on secondary lymphedema for this discussion.
Lymphedema is the Accumulation of protein rich fluid in the interstitial layers of the skin. Secondary lymphedema occurs most commonly in the arms, but can manifest in the legs, head, neck, trunk, or genitals-depending on what part of the lymphatic system is compromised.
Lymphhedema may appear following a medical procedure. It may appear months or years later, or it may not occur at all. Approximately 65-75% of women who undergo breast cancer treatment are at risk for developing lymphedema during their lifetimes. Although lymphedema is not curable, it is highly manageable.
The Difference Between Lymphedema & Edema or Swelling for Other Reasons
If you have a medical history that indicates a risk for developing lymphedema, you should be vigilant in monitoring your arm and hand along with your chest wall on the surgical side for any noticeable swelling. Any swelling that continues unabated for three months or more, or swelling that does not dissipate with elevating the arm and hand, could indicate the presence of lymphedema. If you can push the swollen skin in with a fingertip, and the indentation stays, it is early stage lymphedema. Because of the physical make-up and differences in the two types of edemas discussed here, only the lymhedema contains the protein-rich fluid that provides the physical properties to allow pitting.
Types of Treatment
Lymphedema first appears as swelling. If left untreated, the swelling will not dissipate and can be indented with a fingertip. Untreated, the swelling may increase and the skin will slowly turn fibrotic and feel hard to the touch. The swelling can increase further and eventually cause the skin to split and weep. It is far better to seek treatment early on, but lymphedema conditions can be improved at any stage. When treatment is sought early, the swelling can be reduced and managed to almost normal proportions. If left to become more serious, the hardness and the skin condition can improve, but will probably never return to normal.
The most common treatment with the most success is known as Complete Decongestive Therapy or CDT. CDT consist of four components. The components are, Manual Lymph Drainage (MLD) followed by careful Skin Management. This is followed with Wrapping in bandages to create compression and then a Self-Treatment and decongestive exercise program for the patient. Treatment with CDT will initially be conducted every day for two to four weeks, until the patient’s swelling decreases to a point of plateau. At this time, most patients are fitted with compression garments. These garments are worn all day, everyday. At night, the patient takes off the compression garment and bandages the area before going to bed.
Lymphedema is a life-long concern but can be managed with consisent good habits and compliance.
Manual Lymph Drainage (MLD)
This is a special type of skin manipulation conducted by a trained lymphedema therapist. Unlike massage, which implies deep or vigorous rubbing of the skin and underlying tissues, MLD is done with a light touch in order to manipulate the direction of the lymph flow. MLD is conducted on a regular schedule, usually once a day for two to four weeks. The patient will be instructed in a modified version of MLD to use at home as self-therapy.
Skin Care & Compression Bandaging
Following the MLD session, the therapist will apply lotion to help keep the skin moisturized and to provide a protective barrier between the skin and the compression bandages. The lotion also may contain anti-microbial agents to help allay infection.
The therapist will then bandage the area affected by the lymphedema. The bandages are of various sizes and materials, all applied with a purpose. the overall effect is to construt a “cone” of compression that directs the lymph fluid away from the affected area. This bandaging will be changed at least once a day during active therapy.
With CDT, there will come a point where the dramatic change and decrease in swelling of the area will begin to diminish or plateau. This is the point where there will be little if any further change to the volume, or size, or the area. This is also the time when most patients are fitted for compression garments. Most compression garments are ready-made. Some will have to be custom-made. When fitted for a garment, the patient will wear this garment everyday, all day. Compression garment should be replaced at least once every six months.
At bedtime, the patient will take off the compression garment and replace it with compression bandaging. Alternatives to compression bandages can be obtained. These are referred to as night compression garments. They provide a different type of compression suitable for sleeping.
Your Exercise Program
Lymphedema is best manged with consistent habitual care and patient compliance. The therapist will provide the patient with a specific exercise program to follow at home in order to maintain a decrease in swelling. Careful patient management will minimize the need for therapy sessions. Generally the exercises are gentle and short in length so there is a minimum time commitment required.
When stabilized, your lymphedema should not limit your physical activities as long as you monitor your body carefully for swelling as you increase your activity level over time.
Preventing or Minimizing the effects of Lymphedema
When you are at risk for lymphedema, it is worth the extra care to prevent lymphedema from occurring. Some precautions you can take include the following:
- Keep your skin protected with lotion and wash with gentle soap.
- Avoid cuts, scratches, burns, insect bites and bruises that might increase swelling or promote infection.
- Use the unaffected arm to have blood pressure taken, injections, blood draws and IV’s to reduce the risk of adverse effects.
- Be careful with manicures. Use sterilized instruments and be gentle to avoid nicks and skin tears.
- Avoid restrictive clothing and jewelry.
- Do not carry a purse with the affected arm.
- Do not lift luggage or heavy items, or carry shoulder bags.
- Weight gain can cause lymphedema occurrence. Getting regular exercise and maintaining a healthy weight can help minimize your risk.
- When travelling, be sure to take frequent breaks to get up and move around.
- In a car, take extra care to ajust the seat belt where it is snug but comfortable.
- On a airplane, you should wear your compression garment as rapid changes in air pressure can cause swelling. Generally, put on your compression garment an hour prior to your flight, and wear your compression garment at least an hour after landing to help minimize the effects of air pressure changes.
Living a Full Life
American Breast Care believes in providing you, the patient, relevant information so you can make informed decisions regrading your healthcare. We are dedicated to helping women lead fuller lives after breast surgery.
For more information about American Breast Care visit: www.americanbreastcare.com.
American Cancer Society
National Breast Cancer Coalition
The National Women’s Health Information Center
Sister’s Network, Inc
National Lymphedema Network