Lymphedema and the Lymphatic System
“What is lymphedema?” is a question we hear often at The Center for Breast Restoration. Lymphedema refers to swelling that generally occurs in the arms or legs when the protein rich lymph fluid is unable to drain properly. Lymphedema is caused by a blockage in your lymphatic system, an important part of your immune and circulatory systems. As the lymph fluid builds up the swelling continues resulting in pain, decreased mobility, recurrent soft tissue infections and even permanent disability.
To further explain, we first need a general understanding of the lymphatic system itself, which is where the term lymphedema stems from. The lymphatic system is part of the immune system and helps develop and distribute white blood cells throughout the body to help protect it from foreign substances. It also functions to drain and filter fluid away from regions of the body. It works by collecting excess fluid (lymph) from the spaces between your body’s tissues, moving it through the lymph vessels where it is eventually filtered through lymph nodes before returning to the circulatory system. The role of these lymph nodes is to destroy pathogens and some cancerous cells while filtering out waste products and some fluid. Once this process occurs, the filtered lymph is then carried out of the node to continue its return to the circulatory system.
What are its Symptoms?
The degree of swelling that occurs with lymphedema varies but is often described as feeling as though your clothing, rings, bracelets, etc.. are too tight. Others explain it as having a feeling of fullness in the arms, shoulders, chest, hands or legs and hindered flexibility in their joints.
- Swelling of part of your arm or leg, or the entire arm or leg, including your fingers and toes.
- A feeling of heaviness in arm or leg
- Restricted movement in your arm or leg
- Recurring infections in your affected limb
- Thickening of the skin on your arm or leg
What are its Causes?
Lymphedema can occur as an inherited condition caused by problems with the development of lymph vessels in your body. This congenital condition is known as primary lymphedema. Secondary lymphedema occurs when a condition or procedure damages the lymph nodes or lymph vessels. The most common injury is surgical when lymph nodes are removed for the treatment for a variety of cancers, such as breast cancer. If irradiation therapy to the area is necessary, the condition may worsen.
Lymphedema After Breast Cancer Surgery
Often, during breast cancer surgery, some or all of the lymph nodes under the arm may be removed. These nodes (which are also known as the axillary lymph glands) are responsible for draining the lymphatic vessels from the upper arms, the neck, the majority of the breast and the underarm area. Since mastectomy and lumpectomy surgery can remove these nodes, the result can be an alteration of the normal drainage pattern in the immune system.
Whenever there is a disturbance in the pathway that drains this fluid, and the remaining lymph vessels cannot channel enough fluid from these regions of the body, then this will inevitably cause a build up of excess fluid in this area. This swelling is known as lymphedema. Radiation can also disturb the flow of lymph fluid in the arm, chest and breast in the same manner as surgery, further increasing the chances of developing lymphedema.
The formation of lymphedema after breast cancer surgery is typically something that develops slowly over time. However, it can develop at any time after surgery. If the condition does develop very soon after surgery, it is usually only a mild case and goes away within a week or two. Most women that develop lymphedema after mastectomy or lumpectomy do so many months and sometimes even years after their operation and in these cases, swelling can range from moderate to severe.
As surgical techniques and radiation have improved over the years, there are fewer cases of lymphedema seen today than in previous years. On average, the condition develops in one in four breast cancer patients who have undergone breast cancer surgery and lymph node dissection. The risk doubles for individuals who receive radiation treatments to the underarm in addition to lumpectomy or mastectomy.
Treatment for Lymphedema
At this time, there is no known cure for lymphedema, so treatment focuses on reducing its symptoms which includes exercises, use of compression bandages and garments, and manual lymphatic massage. This type of treatment focuses on reducing the accumulation of lymphatic fluid within the soft tissue of the affected limb.
Surgical treatment has shown some promising improvements in the symptoms of lymphedema but while there is no cure for lymphedema, a lymph node transfer may reduce the symptoms. Lymph nodes from the groin region can be microsurgically transferred to the arm with symptomatic lymphedema. One or two lymph nodes can be harvested in connection with a DIEP/SIEA procedure or as an independent procedure. The node is then transferred to the axilla. Blood flow is re-established to the lymph node by reattaching blood flow of the nodal vessels to the vessels in the axilla. Care is taken when transferring only one or two nodes from the donor site not to cause lymphedema in the region. Patients would then resume manual lymphatic massage and compression garments after the lymph node transfer.
- Good nutrition
- Manual lymphatic drainage
- Compression garments
- Arm pump
- Elevation of the affected limb
- Proper skincare (to avoid infections)
Prevention and Control
Although it is not possible to predict who will develop lymphedema, there are some steps patients can take to lessen their risk. If you have developed lymphedema already, it can be controlled and managed by following some of the guidelines listed below.
- Ask your doctor about daily stretching exercises that can be performed after your surgery to maintain your range of motion
- Do not suddenly increase the amount of physical work performed with the arm on the surgery side. Lymph production is directly proportional to blood flow, therefore, overly strenuous arm exercises that increase blood flow in the arm can increase lymph production and therefore increase the risk of lymphedema.
- Avoid alcohol and drink plenty of water. Avoid foods high in salt and fat. Try to stick to healthy foods that are high in fiber like fruits, vegetables and whole grains.
- Wear comfortable clothing and jewelry that does not squeeze or pinch your arm or hand. A tight sleeve or bracelet for instance can cause fluid to build up in the arm and lead to lymphedema.
- Burns on the hand or arm can increase risk for lymphedema, so avoid overly hot water when bathing or washing dishes, use warm water instead. Always wear sunscreen as well to prevent your skin from burning.
- When sleeping or sitting, try to keep your arm elevated with a pillow and avoid lying on your surgery side for extended periods.
- Take extra care of your skin to avoid infections. Do your best to protect skin from cuts, burns and sores. Wash your hands frequently and wear gloves when doing house or yard work. Apply moisturizer to chapped skin and use insect repellent to avoid bug bites.
These are just a few of the steps you can take to manage and prevent lymphedema. Talk to your doctor about what you can do to prevent lymphedema from developing. Contact your physician at the first signs of lymphedema or if you suspect an infection is developing.