What is Lymphedema?
For women who have undergone breast cancer surgery and/or radiation treatment, arm lymphedema is a possible side effect that can occur after treatment.
The axillary lymph nodes can be the first place cancer spreads from the breast which is why they are removed and tested for cancer cells with sentinel lymph node biopsy or more extensive lymph node removal (axillary dissection).
Lymphedema develops when the lymphatic fluid "backs up" in patients who have had lymph nodes removed, had cancer involvement of the lymph nodes, or had radiation to the axilla. It occurs in 7% of women undergoing sentinel lymph node biopsy and up to about 45% of women undergoing axillary node dissection. Post-surgical radiation therapy increases the likelihood of arm lymphedema further.
Signs and symptoms of upper extremity lymphedema after breast cancer treatment can include:
- Swelling in arms, hands, fingers, shoulders or chest
- A feeling of heaviness or tightness
- Restricted range of motion
- Aching or pain
- Decreased flexibility in the hand or wrist
- Hardening and thickening of the skin on your arm
Once lymphedema develops, the affected arm is susceptible to even more swelling. Patients should take care to protect that arm and hand from infection. Avoid cuts, scratches, burns and iv's to that extremity and take care to clean any injuries thoroughly.
There are non-surgical and surgical treatment options for lymphedema.
Non-surgical options must always be exhausted before considering surgery. Treatments involve specialized physical therapy from certified lymphedema specialists. Modalities include range of motion exercises, elevation, “lymphatic” massage, compression garments, intermittent pneumatic compression devices, and special types of banding. Non-surgical treatment can be very effective in mild and mild-to-moderate cases. The most obvious benefit is that the patient avoids further surgery. The main disadvantage is that non-surgical treatment is not always definitive and many patients find some of these treatment modalities cumbersome.
Vascularized Lymph Node Transfer
Of all the surgical treatment options, vascularized lymph node transfer has shown the most exciting results. The procedure involves transplanting healthy lymph nodes from another part of the body, most commonly the groin. These lymph nodes can be transplanted to the axilla (armpit) at the same time as breast reconstruction with a DIEP flap, or as a stand-alone procedure. Both methods can permanently reduce or even eliminate lymphedema in some cases. Currently, PRMA only offers the procedure in conjunction with DIEP flap reconstruction.
Vascularized lymph node transfer will only be considered for patients who have already maximized control of their lymphedema through lymphedema therapy. Patients must also return to lymphedema therapy after vascularized lymph node transfer to ensure the best results.