The risk of lymphedema developing is approximately 5-8% after a sentinel node biopsy, and can be as high as 20-25% after full axillary node dissection. The risk of developing lymphedema increases with the number of lymph nodes removed, but it can occur with the removal of only one lymph node. We do not fully understand why some women develop lymphedema while others do not, although obesity, extent of breast cancer surgery, injury to the arm, and other factors may play a role. Lymphedema usually develops gradually over time. The swelling can range from mild to severe, and it may develop at any time following surgery or radiation therapy.
Historically, women were advised to restrict arm movements after breast cancer surgery. In addition, it has long been recommended to avoid using the “cancer side” arm for blood pressure checks, blood draws, intravenous lines, and injections. Patients have been told never to have their cuticles cut and to avoid heavy lifting. However, many of these “rules” have recently been called into question. It is often recommended that patients try to avoid blood draws and blood pressure checks on the side of the surgery, but there is limited good-quality data regarding the impact of these practices on the development of lymphedema. It is also often recommended that patients wear a compression sleeve if they will be flying, but studies are mixed regarding the effectiveness of this practice in reducing lymphedema.
Patients should be encouraged to resume normal range of motion as soon as possible after surgery. If reconstruction has been performed, the plastic / reconstructive surgeon should be consulted as they may recommend some activity restriction for a period of time. A gradual return to exercise, including light weight lifting, is encouraged, but patients should always follow the recommendations of their treatment team.
There should be a low threshold for seeking medical attention if worsening of the swelling, redness or an increase in pain are noted. Infections can progress quickly and may be severe.
This information applies to patients without clinical signs of lymphedema. If lymphedema has already developed, precautions need to be followed to minimize any trauma to the affected arm. A certified lymphedema specialist can be very helpful in terms of treatment and education.
Up until recently, we have only been able to detect lymphedema through physical signs, such as tightening of the skin of the hand and forearm, difficulty putting on or taking off rings and watches, and changes in arm measurements. Unfortunately by the time swelling becomes obvious, it is more difficult to treat.
Bioimpedence spectroscopy (BIS) is a method of non-invasive assessment that can more precisely evaluate a patient for early evidence of lymphedema before tightness and swelling develop. With early detection and intervention, studies have shown that the development of clinical (obvious on the exam) lymphedema may be halted. BIS is not available in all facilities and is not always covered by insurance.
Treatment and Prevention
The axillary reverse mapping is a surgical technique that shows promise in reducing the likelihood of lymphedema developing – a multi-center research trial is currently underway. There is also a lot of interest in lymphatic-venous anastomosis either at the time of sentinel node biopsy or as a treatment option once lymphedema develops. Lymph node transfer/transplant is also being evaluated and performed at some specialized facilities.
Additional information can be found at the following sites:
National Cancer Institute
National Lymphedema Network
American Cancer Society