Overview 

If you’ve undergone surgery for breast cancer and are worried about lymphoedema, you’re not alone. Lymphoedema is a condition caused by fluid retention in the arm or chest areas due to the disruption of the lymphatic system, which can be a long-term concern, as it affects mobility, appearance, comfort, and quality of life. 

The good news about lymphedema is that its treatment is fairly effective and can also be prevented or managed effectively with the right care and information. With the right care, many individuals assigned female at birth (AFAB) can effectively manage their lymphedema and continue to live confidently. 

In this article, we will explore what you need to know about lymphedema after breast cancer surgery. Whether you’re currently facing lymphedema or looking to reduce your risk, carry on reading for evidence-based guidance and supportive advice.

What is lymphoedema, and what are the risks of developing it after breast cancer surgery? 

Lymphoedema is a chronic condition that results from damage or blockage to the lymphatic system. The lymphatic system is responsible for draining excess fluid and waste products from the body’s tissues, and when lymph nodes are removed or damaged, like in breast cancer surgery, or radiation therapy, lymphatic fluid can accumulate in the surrounding tissue, leading to swelling .¹ This is most commonly seen in the arms, chest, or breast area, where the surgery was performed. The buildup can lead to discomfort, heaviness, and reduced mobility. 

Lymphoedema develops in 1 in 5 persons AFAB  who undergo breast cancer treatments.² The risk varies depending on the type of surgery and any other treatments, like radiation.  

Individuals AFAB who undergo sentinel lymph node biopsy, a procedure where not many of the lymph nodes are removed to assess the spread of cancer.³ This type of biopsy has a lower risk of developing lymphoedema. However, for persons AFAB who have axillary lymph node dissection, where more lymph nodes are removed, in these cases, the risk of lymphoedema significantly increases.

If axillary lymph node dissection is used with regional nodal radiation therapy, a type of radiation that targets remaining cancer cells in the lymph nodes, it reduces the chance of the cancer recurring or spreading to other parts of the body.⁴ This increases the risk, as it causes additional damage to the lymphatic nodes, making fluid drainage harder. 

Surgical and personal risk factors of lymphoedema

• Surgical procedures like axillary lymph node dissection, where multiple lymph nodes are removed, or sentinel lymph node biopsy, which removes fewer nodes  
• Having a high body mass index can put pressure on the lymphatic system and lead to poor drainage^3,4 
• Age is also a factor which affects lymphoedema. Being older may reduce the body’s ability to efficiently recover from surgery or heal any damage caused by surgery or radiation therapy⁵
• Not being physically fit can cause stagnant lymph fluid, not aiding the drainage, and allowing the buildup of lymphatic fluid  
• Infections or injuries to the affected area can cause inflammation, which can worsen blockage to the lymph nodes, triggering or worsening lymphoedema 

Can lymphoedema be prevented?

Not all cases of lymphoedema can be prevented, but proactive management can significantly reduce its likelihood. Having good skin hygiene is primary, as keeping the skin clean and well moisturised can help prevent infections like cellulitis, which can trigger or cause worsening of lymphoedema. Regular exercise is also beneficial, as the movement promotes lymphatic circulation, reducing any blockages. Walking, stretching, and light weightlifting are effective and safe methods to do this. Obesity is also a risk factor for lymphoedema, so managing a healthy weight and body mass index can reduce the strain of lymphoedema.^7,9 

Moreover, avoiding injuries to the affected arm is crucial, as minor injuries like burns or small cuts can increase the risk of developing lymphoedema in individuals who’ve had surgical removal of lymph nodes or radiation therapy. 

In more recent years, preventative surgery like immediate lymphatic reconstruction can be used during breast cancer surgery. It involves reconnecting the cut lymphatic vessels to veins that are nearby during an axillary lymph node dissection.⁶ The reconstruction aims to reduce the risk of swelling and fluid buildup in the arms and allows drainage. 

Treatment options

When lymphoedema occurs, the treatment goal is to alleviate the symptoms and prevent progression. Complete decongestive therapy is a treatment approach used to manage the swelling and fluid buildup. This therapy uses several techniques to reduce the swelling and improve the skin condition, improve mobility and overall improve the quality of life.

Complete decongestive therapy involves manual lymphatic drainage, which is a massage technique that encourages lymph fluid to be drained from the affected areas where there is blockage. Compression bandaging: This technique uses stretchy bandages to help reduce swelling.¹⁰ 

There are two phases to complete decongestive therapy: an intensive phase and a maintenance phase. The intensive phase involves daily treatment under the guidance of a therapist, and the maintenance phase is performed when the initial swelling has reduced and the patient continues to practice the techniques learnt from the intensive phase, to maintain the progress.¹¹ 

Low-level laser therapy can also be used. This treatment involves using a lower-intensity laser and applying it to the affected area to reduce the swelling and slow down the progression of lymphoedema. This technique uses a red light which penetrates the skin and stimulates healing in the body, it also promotes the flow of lymph fluid, reducing retention in the tissue.⁸ This helps with mobility and swelling, improving overall quality of life. 

Living with lymphoedema

Managing lymphoedema is a process that not only includes medical treatment but also lifestyle adjustments. Daily routines include. Daily routine checks for skin changes and swelling, and continuing the required physio and using compression garments. Having emotional support is also important, as the battle with mental health and body image can negatively impact your quality of life. It can be beneficial to seek counselling and attend support groups.¹² With the right guidance and adherence, individuals can maintain an active, comfortable life despite living with lymphoedema. 

Summary 

Lymphoedema is a common side effect of breast cancer treatment, especially for persons AFAB who undergo lymph node removal or radiation therapy. As not all cases can be prevented, it is important to understand the risk factors and be proactive to reduce the chances of developing the condition. When lymphoedema does occur, early diagnosis and treatment are important to manage the condition. By combining surgical and holistic approaches, patients can manage symptoms and maintain their quality of life.