Lymphedema Following Breast Surgery

Who is at risk?
Anyone who has had an axillary lymph node dissection as part of breast cancer surgery is at increased risk for upper extremity lymphedema. Sentinel node biopsies also carry a risk of lymphedema, but to a much lesser extent. Lymphedema can occur immediately postoperatively, within a few months, a couple of years, or as late as 20 years after treatment. With proper education and care, the incidence of lymphedema can be minimized, or if it develops, kept well under control.

What are the signs and symptoms of lymphedema?
Since it is important that lymphedema is treated early, it is important to recognize the signs and symptoms. You should contact your doctor or nurse if you develop any of the signs or symptoms of lymphedema:

• Numbness or tingling of your arm or hand
• Tightness of the skin
• Decreased flexibility in your hand or wrist
• Difficulty fitting into your clothing or jewelry
• Persistent swelling (seek medical advice promptly)
• Warmth or redness of your hand or wrist (report this to your doctor immediately, as this may be a sign of infection)

How can I reduce my risk of developing lymphedema?
Although there is no way of totally preventing lymphedema, there are steps you can take to decrease your risk or to control the progression if it were to occur. The following are guidelines and should not be restrictive. If you have questions regarding certain activities, please contact your healthcare provider.

Maintain meticulous skin and nail care in the affected arm

• Keep arm clean
• Dry the arm carefully after bathing, especially in between fingers
• Use lotion with a low pH (e.g., Eucerin® or Aquaphor®) after bathing and apply frequently in dry and cold climates
• When manicuring nails, avoid cutting cuticles – instead use cuticle cream or push them back gently after bathing or showering
• Watch for signs of increasing redness or swelling that may suggest infection

Limit activity that increases lymph flow to the arm

• Avoid heavy lifting using the arm
• Before beginning an exercise, check with your healthcare provider
• Avoid vigorous, repetitive motions using the arm

Protect your arm from cuts, bruises, or other trauma

• Avoid injections, blood draws, or IVs in the involved arm
• Wear gloves while doing housework and gardening
• Use oven mitts when handling hot objects
• When sewing, use a thimble to avoid pinpricks
• Avoid exposing the arm to extremes of temperature
• Use an electric razor when shaving the affected underarm
• Apply antibiotic ointment to even insignificant cuts and scratches
• Use insect repellant to avoid insect bites
• Use sunscreen to avoid sunburn

Minimize construction around the arm of concern

• Blood pressure should be taken on the unaffected arm
• Do not wear tight clothing or jewelry on the affected arm
• Avoid sleeves with tight elastic bands
• Avoid carrying handbags, briefcases, or luggage on the affected limb

How is lymphedema treated?
The diagnosis of lymphedema must come from your physician. There are many different conditions that can cause swelling of a limb. You will need to undergo a thorough evaluation by your physician prior to beginning treatment for lymphedema.

Although there is no cure for lymphedema, there is treatment. Complete decongestive therapy (CDT) is a highly effective technique for managing lymphedema. CDT combines manual lymph drainage (a gentle massage technique for stimulating the lymphatic system), careful skin care, compression bandaging, and exercises to promote joint mobility. After the intense phase of treatment, the patient is measured for a compression garment that is to be worn throughout the day to prevent swelling from returning. A certified lymphedema therapist performs the treatment.

Maintaining your ideal body weight can help to control lymphedema. This can be challenging since certain medical treatments cause weight gain and can make the task of weight control even more difficult. Nutritional and emotional counseling are available through the Cancer Center and may prove helpful.

How can I schedule an appointment?
Call 1-800-789-PENN (7366) for more information or to schedule an appointment with Christine Robertson, Occupational Therapist and Certified Lymphedema Therapist. She is located at the Sports Medicine Center at Pennsylvania Hospital, 330 South 9th Street (corner of 9th and Pine Streets). You can also request an appointment online.

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.