Being Proactive About Lymphedema

Lymphedema is a frequent topic of conversation in many of our post-op visits after mastectomy and reconstruction. It is true that your personal risk for lymphedema is increased by having breast surgery, but this risk may be exaggerated in educational resources online; your worry about lymphedema can then also be exacerbated by repeated mentions of it’s effects by friends or loved ones. Navigating this topic, therefore, can be challenging.

As a practice, it is our goal to always provide our patients with the education they need to make informed decisions. Below you will find a resource we created to address some basic questions regarding lymphedema. As in any setting regarding your health, if you have additional questions, please reach out to us or ask your primary care doctor.

Being Proactive About Lymphedema

Breast cancer related lymphedema is a chronic swelling of the upper limb following breast and/or axillary lymph node surgery. It has varying degrees of severity. Lymphedema is uncommon in women who have had a mastectomy with a sentinel lymph node biopsy (SLNB) regardless of the number of sentinel nodes taken. However, risk increases if you have had an axillary lymph node dissection (ALND) and/or radiation to the breast and/or axilla (armpit). Other factors that have been associated with increased risk for lymphedema after mastectomy include infection, obesity/overweight (BMI>25), increased age, and poor overall health status. The more risk factors you have, the greater the risk for developing lymphedema.

Lymphedema cannot always be prevented, but if you are at higher risk for lymphedema, there are strategies that can be employed to reduce risk for lymphedema. The information below will introduce you to these general strategies. For more specific information, or if you are at high risk for lymphedema, we recommend seeing a physical therapist who is certified in lymphedema care. Please feel free to ask us for a referral should you need one.

Worry regarding lymphedema after breast surgery can, alone, be very devastating to quality of life. Remember, your risk for lymphedema is relatively low if you have not had an axillary node dissection or radiation to the breast or axilla. If you are at relatively low risk but still have worry about lymphedema, please ask us or your medical doctor.

Skin Care Instructions

Preventing lymphedema is an extremely important aspect of lymphedema care in those patients with risk factors for lymphedema (especially those patients who have had ALND and/or radiation). The following strategies can be used to reduce your risk of developing lymphedema. If you notice any limb swelling, please call your doctor.

These recommendations apply to your affected limb.

1. DAILY SKIN CHECK

1. Examine your arm and hand daily for cuts, burns, or bites; these are potential sources of infection. Check all folds and in-between fingers. Be sure to check any areas that are numb by looking at the area or feeling with your fingers.
2. Treat skin openings with an antibiotic cream (such as Neosporin, Bacitracin, etc.) and band-aids to protect wounds from infection.
3. Be aware of signs of infection which include redness, warmth, tenderness, pain, red streaks, or swelling. Call your doctor immediately if you have these symptoms.
4. Carefully inspect hands for hangnails and cracked or torn cuticles; if present, make sure to keep these areas clean by washing with soap and water.
5. Lotion or cream use can help avoid cracks in your skin due to dryness. Use lotions as needed to keep your skin moist.

2. AVOID INFECTION

1. Keep your arm, especially between fingers. Dry well in all creases.
2. Wash your garments and stockinet layer of bandages (if applicable) daily. Wash elastic bandages after no more than four wearings.
3. Keep your cuticles moist with cream and push them back, without cutting them.
4. Use gloves when doing dishes, loading dishwasher, cleaning house, gardening or when doing any other “dirty” work. Turn gardening gloves inside out and wash them at the end of each gardening session.
5. Always offer the other arm for injections or blood tests. Depending on your risk factors, recommendations for blood pressure measurements can differ; this should be discussed with your doctor. If you have had an axillary node dissection or radiation, try to avoid blood pressure measurements on that side.
6. Use an electric shaver to remove hair in affected areas, as blade shavers may introduce infection.
7. Use a thimble when sewing.

3. AVOID MUSCLE STRAIN

1. Use your arm as normally as possible. Activities that require full range of motion of your arm are okay; there is no need to avoid using your arm in normal day to day activities.
2. Discuss any questions regarding lifting restrictions with your therapist. If you are low risk for lymphedema, lifting restrictions are often not needed.
3. Begin any new exercise program slowly, increase gradually and monitor your arm carefully. Be sure to warm up and cool down properly. Swimming, walking, bicycling, dancing and yoga are suggested. Aerobics classes may be acceptable. Use of light weights with high repetition is acceptable. Tennis, golf, and racquetball may be okay, but may increase swelling in some people; if you are high risk for lymphedema, discuss this with your therapist. Contact sports are best avoided.
4. Discuss your exercise preferences with your therapist for specific guidelines; your therapist may recommend measuring your limb on a regular basis to gain feedback about how your exercise program is affecting your lymphedema.

4. AVOID SUNBURNS & BURNS

1. Use a high SPF sunscreen on the arm at risk, and on the trunk quadrant, whenever in the sun.
   1. Use extra long oven mitts to protect hands and forearms from cooking burns.
   2. Smokers should hold their cigarettes in the other hand.
   3. Practice taking covers off microwaved food with the other hand.
   4. Use caution with heated hair styling aids.

6. AVOID CONSTRICTION

1. Carry your purse on the other shoulder and lighten its load, if possible.
2. After breast surgery, wear the lightest weight prosthesis you can manage.
3. Wear a loose watchband, or wear your watch on the other arm. Avoid tight jewelry.
4. Underclothes should not bind at the chest or underarms. Check bra size, especially if you gained weight from chemotherapy.
5. Be sure clothes are loose at wrists.

7. FLYING WITH LYMPHEDEMA

1. Flying after breast surgery is okay.
2. If you have lymphedema and have been prescribed a compression garment for treatment of your lymphedema you should wear that garment when flying. There is no clear rationale for wearing a compression garment when flying if you do not have lymphedema.