What is the lymphatic system?

The lymphatic system helps the body fight infection. It's a network of tiny vessels and small, bean-shaped organs called lymph nodes. The vessels carry lymph throughout the body. Lymph is a clear, colorless fluid that contains proteins, salts, water, and white blood cells. The nodes filter lymph to help fight infection.

The lymph system helps protect and maintain the fluid balance of your body. It filters and drains lymph and waste products away from every part of the body. The lymph is carried back to bigger vessels near your heart.

How lymphedema happens in breast cancer

The lymph nodes under the arm are called the axillary lymph nodes. They drain the lymphatic vessels from the upper arms, most of the breast, and from the chest, neck, and arm pit. During surgery for breast cancer, these nearby lymph nodes (and vessels) are often removed. This disrupts the flow of lymph. The axillary lymph nodes also might be treated with radiation therapy. This can cause damage and scarring that also affects the way lymph flows through that area. All of this can lead to fluid buildup and swelling on the affected side. This is lymphedema.

When many lymph nodes under the arm have been affected, you are at higher risk for lymphedema for the rest of your life. Swelling can get worse and become severe. Skin sores, infection, pain, and other problems can develop.

Lymphedema may start right after surgery or radiation, or months or even years later.

• A mild type of lymphedema happens within a few days after surgery. This is normal. It usually lasts a short time.

• Lymphedema can also happen about 4 to 6 weeks after surgery or radiation and then go away over time.

• The most common type of lymphedema is painless. It tends to slowly develop, most often within three years of surgery. It does not get better without treatment.

Can lymphedema be prevented?

Lymphedema can happen any time after surgery or radiation to the lymph nodes. The risk continues for the rest of the person's life. Lymphedema can’t be cured, but it can be managed. Any swelling should be checked by a health care provider right away.

Doctors don't know who will or won't get lymphedema. But there are things that can be done to help prevent it.

People treated for breast cancer who take good care of their skin and exercise after treatment may be less likely to develop lymphedema. Staying at or getting to a healthy weight may also help lower your risk.

Newer types of lymph node surgery have also helped lower lymphedema risk. But there's no sure way to prevent lymphedema.

Preventing infection and injury

Protecting the arm on the side of the surgery is very important after breast surgery. Poor drainage of the lymphatic system can put that arm at risk for infection. Poor drainage can also make the arm less sensitive to extreme temperature. Be aware of activities that put too much stress on the affected arm.

To protect your arm from injury and infection, make sure to:

• Ask your health care provider if it's OK to have your blood pressure taken, blood drawn, injections, or an IV (intravenous) line put in the affected arm. You may be advised to not have these done on your at-risk arm if possible.

• Not wear tight jewelry or clothing with elastic cuffs or tight bands.

• Carry your handbag or heavy packages with the unaffected arm or both arms.

• Be very careful and use a clean razor when shaving underarms.

• Prevent sunburns and other burns to the affected arm.

• Wear gloves when gardening and when using strong household cleaners.

• Clean the skin of the affected arm daily, gently dry well, and apply lotion.

• Do approved exercises regularly to improve drainage.

• Eat a healthy, low-sodium diet.

• Not put extreme hot or cold temperatures on the affected arm. This includes hot tubs, saunas, and heating pads or ice packs.

• Take good care of your fingernails. Don’t cut or bite your cuticles.

• Clean all cuts with soap and water. Put antibacterial ointment and a sterile dressing on the cut.

• Protect your fingers from needle pricks and sharp objects. Use a thimble when sewing.

• Not do vigorous, repetitive movements against resistance with the affected arm. This includes scrubbing, pulling, or pushing.

• Tell your provider right away if you have any signs of infection. These include redness, pain, heat, increased swelling, or fever.

Symptoms of lymphedema

The main symptom of lymphedema after breast cancer treatment is swelling of the arm on the side where lymph nodes were removed. The amount of swelling may vary. Some people may have severe swelling (edema). The affected arm can be several inches larger than the other arm. Others will have a milder form of edema where the affected arm is only slightly larger than the other arm.

Other symptoms of lymphedema may include:

• Feeling of fullness, heaviness, or tightness in the arm, chest, or armpit area.

• Your bra, clothing, or jewelry don't fit as normal.

• Aching or new pain in the arm.

• Trouble bending or moving a joint, such as the fingers, wrist, elbow, or shoulder.

• Swelling in the hand.

• Thickening of or changes in the skin.

• Weakness in the arm.

If you notice any of these symptoms, see your health care provider right away. Treatment needs to be started right away to keep lymphedema from getting worse.

How is lymphedema diagnosed?

There are no tests for lymphedema. Instead, your health care provider will ask about your health history and do a physical exam. You’ll be asked about:

• Past surgeries you’ve had.

• Any problems after your surgeries.

• When the swelling started.

• If you’ve had severe swelling in the past.

• What medicines you’re taking.

• What other health conditions you have. These might be high blood pressure, heart disease, or diabetes.

You may need other tests to diagnose lymphedema. These include imaging tests, measures of volume, and blood tests.

Treatment for lymphedema

Treatment depends on how severe the problem is. Treatment focuses on ways to help prevent and manage the condition. It may include:

• Exercise. Exercise helps improve lymph drainage. Your care team, certified lymphedema therapist, or physical therapist will recommend specific exercises. 

• Bandages. Wearing a compression sleeve or elastic bandage may help to move fluid. It can also prevent fluid buildup. Ask your care team if this treatment is right for you.

• Diet and weight management. Eating a healthy diet and controlling your weight are an important part of treatment. Ask your health care provider what a healthy weight is for you.

• Elevation. Raising your arm above the level of your heart when possible lets gravity help drain fluid.

• Preventing infection. It’s important to protect the skin in the affected area from drying, cracking, infection, and skin breakdown.

• Massage therapy. Massage by a certified lymphedema therapist can help move fluid out of the swollen area.

Ask your doctor for a referral to a certified lymphedema therapist. This is a provider who specializes in lymphedema teaching and management.

Working with your doctor 

Talk with your care team about what you can do to try to keep lymphedema from happening to you. Make these precautions part of your daily habits. Plan to follow them for the rest of your life.

Compare your hands and arms. Look at them in the mirror. Learn what's normal for you so you can notice changes right away. If lymphedema does develop, let your care team know right away. You can take steps to try to keep it from getting worse.