Lymphedema – prevention after Mastectomy

Lymphedema is a potential side effect of breast cancer surgery and radiation therapy. It is an abnormal collection of high-protein fluid just beneath the skin. This swelling, or edema, occurs most commonly after mastectomy in the arms, but it also may occur in other parts of the body including the breast or trunk. Lymphedema usually develops after lymph nodes are removed.

Lymphedema can occur immediately postoperatively, within a few months, a couple of years, or 20 years or more after mastectomy. With proper education and care, lymphedema can be avoided or, if it develops, kept well under control.

The following instructions should be reviewed carefully and discussed with your physicial therapist

  • Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers, neck or chest wall.
  • Never allow for an intravenous injection, or a blood drawing in the affected arm(s).
  • Have blood pressure checked in the unaffected arm.
  • Keep the affected arm, spotlessly clean. Use moisturizer after bathing. When drying it, be gentle, but thorough. Make sure that the arm is dry between fingers.
  • Avoid vigorous, repetitive movements against resistance with the affected arm (scrubbing, pushing, pulling)
  • Avoid heavy lifting with the affected arm. Never carry heavy handbags or bags with over-the-shoulder straps.
  • Do not wear tight jewelry or elastic bands around affected fingers or arm(s).
  • Avoid extreme temperature changes when bathing, washing dishes, or places like sauna or hot tub. Keep the arm protected from the sun.
  • Avoid any type of trauma (bruising, cuts, sunburn or other burns, sports injuries, insect bites, cat scratches).
  • Wear gloves while doing housework, gardening or any type of work that could result in even a minor injury.
  • When manicuring your nails, avoid cutting your cuticles (inform your manicurist).
  • Exercises are important, but consult it with your physical therapist. Do not overstrain arm; if it starts to ache, lie down and elevate it.
  • Recommended exercises: walking, swimming, light aerobics, bike riding or yoga.
  • When traveling by air, patients with lymphedema (or those at risk) must wear a compression sleeve. Additional bandages may be required on a long flight. Increase fluid intake while in the air.
  • Patients with large breasts should wear light breast prostheses (heavy prostheses may put too much pressure on the lymph nodes). Wear a well-fitted bra; not too tight and with no wire support.
  • Patients with lymphedema should wear a well-fitted compression sleeve. At least every 4-6 months, see your therapist for follow-up. If the sleeve is too loose, most likely the arm circumference has reduced or the sleeve is worn.
  • Warning: If you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately. An inflammation or infection in the affected arm could be the beginning or a worsening of lymphedema.
  • Maintain your ideal weight with a well-balanced, low-sodium, high-fiber diet. Avoid smoking and alcoholic beverages. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid – rather this will weaken the connective tissue and worsen its condition. The diet should contain protein that is easily digested, such as chicken, fish or tofu.

Unfortunately, prevention is not a cure. However, as a lymphedema patient you may consult all the worries with your physician and continue the treatment of your lymphedema.