Lymphoedema is an accumulation of excess fluid in any body part that has experienced damage to the lymphatics. After breast cancer, it is generally characterised by swelling of the hand, arm, breast, or torso on the affected side and is associated with significant physical, functional, psychosocial, and economic burden for those who develop this chronic condition.

The lymphatic system is a network of glands connected throughout the body by tiny vessels called lymph vessels. Lymph vessels contain lymph. Lymph is a yellow fluid with cells called lymphocytes. Lymphocytes help fight disease. The lymph flows through the lymphatic system and eventually drains into veins. This system helps to get rid of waste products from the body.

Lymphoedema is associated with surgical removal of lymph glands and radiation to the axilla. Being overweight in combination with surgery and radiation increases your chances of getting lymphoedema, so watch your weight.

Lymphoedema occurrence after breast cancer treatment is estimated up to 70% and is diagnosed as late as 30 years after treatment. Early recognition and treatment of lymphoedema provide optimal outcomes and may alleviate or minimize the physical and emotional burden.

Lymphoedema measurement should be done on diagnosis of cancer, before or immediately after breast cancer surgery, as a baseline measurement.

Some of the signs of developing lymphoedema in your arm is a “feeling of heaviness” in the arm, a “feeling of tightness” (garments and/or jewellery), and greater difficulty with movement and daily activity.

If the surgery involved removal of some or all of your lymph glands, or when you undergo radiation to your axilla, you may be at risk to develop lymphoedema. The average time of onset is approximately 3½ years, but it may start earlier or even a lot later.

Guidelines to help prevent lymphoedema

Minimize restrictions to lymph flow
Restricting lymph flow slows clearance of fluid from the limb. Assist by not wearing tight bra’s, tight sleeves, tight jewellery, etc. Carry handbags on your non-compromised shoulder, and avoid sleeping on your operated arm if possible.

Minimize exposure to heat
Overheating causes the body to produce extra fluid which can build up in the limb. Avoid saunas, spa’s, long hot showers, excessive exercise, sprains and bruises. Take care in climates with high humidity. Avoid direct heat from heaters, open fires or electrical blankets left on, directly over the affected limb.

Minimize sustained muscle tension
Keeping your muscles contracted for any length of time (like when carrying heavy objects) can trigger lymphoedema. Repetitive actions like typing, piano playing, driving long distances, painting the house, gardening could also be culprits. Do everything in moderation.

Medical treatments and your compromised limb
Avoid having injections in, or blood taken from the affected limb unless it is an emergency. Blood pressure should also be taken from the other limb, or if both arms are affected, on your leg.

Future surgical procedures
Removal of lumps, sunspots, ganglion, shoulder reconstruction etc. may trigger lymphoedema. Always mention the removal of your lymph glands to prospective surgeons.

Treatments to the arm
No infrared, interferential, microwave or shortwave currents to be applied to your affected arm. No needling treatments or acupuncture to the arm. Learn from a qualified physiotherapist how to do the gentle stroking massage (as light as stroking a cat) to assist in clearing lymph fluid.

Limb care
Your skin is your barrier to infections, so try to keep it intact. File your nails carefully and don’t pick or bite cuticles. Wear gloves when gardening or doing the dishes. Treat minor cuts and grazes or burns promptly to avoid infection. Use hand cream regularly to prevent dryness. When applying hand cream to the arm, use upward stroking movements. Shave underarms with an electric shaver to minimize the risk of nicking the skin.

Travelling
On flights longer than 3 hours, or if you fly weekly, wearing a support stocking on your arm may be of benefit, as well as performing hourly exercises. If travelling to areas of high temperature or humidity, or to high altitudes (skiing holidays or hiking), wearing a support stocking may reduce the risk of lymphoedema. If carrying a backpack, make sure to fasten the strap to distribute the weight. Always use luggage with wheels or ask a porter to help you.

To summarize, assist lymph flow, avoid heat, minimize risk of infection and beware of varying muscle tension. If your arm feels heavy or aches, stop the causative activity and rest to allow your lymph system time to drain excess fluid. Elevate your arm on pillows and do gentle pumping exercises.