July 2016 Ask the Expert: Lymphedema
Lymphedema is a condition in which extra lymph fluid builds up, causing swelling in tissues under the skin of the hand, arm, breast or torso. It is a common side effect of breast cancer treatment. Whether you are living with this condition or you've heard about it and are hoping to avoid it, you may have questions about lymphedema.
In July, Living Beyond Breast Cancer expert Lori B. Ranallo, RN, MSN, ARNP-BC, CBCN, answered your questions about lymphedema, including how to lower your risk of developing it, how to treat it and how to maintain your quality of life.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
There are many different types of reconstruction. We occasionally see swelling of the arm on the side where lymph nodes were removed when patients have tissue expanders and during the fill stages of the expanders. This is most likely due to added pressure on the lymphatics in the chest. This swelling generally resolves when the permanent implants are placed.
Autologous reconstruction such as TRAM (transverse rectus abdominis muscle), DIEP (deep inferior epigastric perforator), Latissimus flap or (SGAP) superior gluteal artery perforator surgeries in general do not increase the risk of lymphedema. The primary cause of lymphedema is removing axilliary lymph nodes.
Travel by airplane is a controversial topic in the field of lymphedema prevention. There are a few isolated case reports of lymphedema developing in the arm on the side where lymph nodes were removed following air travel. But most research indicates the risk of developing lymphedema is directly influenced by:
- the number of lymph nodes removed at the time of surgery
- whether the patient received radiation therapy
- infection in the arm on the side where lymph nodes were removed
Microvascular lymph node transfer (LNT) is the most promising surgical option for patients with lymphedema in the arm on the side where lymph nodes were removed. It appears to provide significant improvement, especially in early-stage lymphedema. According to limited research, about 50 percent of patients had improvement in the swelling. There are active studies to continue research on this technique, and there are surgeons across the country using this surgery to decrease lymphedema.
Research shows weight loss can help decrease the risk of lymphedema and improve the condition in those diagnosed with lymphedema. There are recent studies that show eating a well-balanced diet, increasing exercise and decreasing your BMI (body mass index) may decrease the risk of lympehdema. You can find more nutrition information from the National Lymphedema Network.
Exercise does not increase the risk of developing lymphedema. Increasing the heart rate and respiratory rates by cardio exercise helps circulate lymphatic fluid and may help reduce the risk of developing lymphedema. Lifting weights may also help build muscle tone and decrease the risk of lymphedema in some women. Make sure you check with your doctor for any restrictions. If your risk of lymphedema is high you may consider wearing a compression sleeve during strenuous activity. If the activities cause swelling or unusual pain – stop.
Certainly the risk of lymphedema is greater depending on how many lymph nodes have been removed. The risk is about 35 percent in women with a full axillary lymph node dissection. Maintaining a healthy weight, staying active and avoiding infection in the arm are all strategies for reducing your risk. Stretching exercises with yoga are generally thought to be safe. Discuss further with your doctor and your yoga instructor. If specific movements cause pain or swelling then those activities should be avoided.
Most clinicians agree that needle sticks and blood pressures should be avoided in arms affected with lymphedema. It may be possible to have blood pressure readings taken at the wrist, but check with your local lymphedema therapist who has worked with you in the past.
The risk of lymphedema is a lifelong risk. It does not decrease over time. The risk is directly related to the number of lymph nodes removed during surgery, and whether the area has become infected. With an axillary lymph node dissection it is recommended to avoid needle sticks and repeated injury to the lymphatics (which may be caused by things like blood pressure cuffs).
Lymphedema is becoming more accepted as a chronic medical condition that requires therapy. The more people who seek treatment and put pressure on their insurance companies to cover costs, the better things will be for all those dealing with this condition. Contact your state's insurance commissioner and tell your story – be an advocate!