Lymphedema Causes, Treatment and Prevention
By: Dr. Gary Arishita & Brandy (Korman) Haslam
For women who have undergone breast cancer surgery or radiation treatment, lymphedema is a possible side effect that can occur months or even years after treatment is finished.
The lymphatic system returns lymph fluid back from the tissues to the blood. Lymph nodes in the axilla, arm pit area, filter fluid returning from the breast. The axillary lymph nodes also filter fluid returning from the arm. They are responsible for removing waste, bacteria and other substances from the lymph fluid as it returns to the body. They can be the first place cancer spreads beyond the breast. When lymph nodes are no longer present or unable to function normally, fluid can back up in the tissues resulting is swelling known as lymphedema.
Lymph nodes are usually removed and examined when treating breast cancers. The lymph nodes are examined to determine if the cancer has spread, or metastasized, to the lymphatic system. If the lymph nodes are involved with cancer, treatment such as chemotherapy and radiation may be recommended. In the past, many (20-30) lymph nodes were routinely removed at the time of lumpectomy or mastectomy. In early stage breast cancers, sentinel lymph node biopsy is now often performed. Radioactive tracer, and/or blue dye is injected into the breast. The injection helps to guide your surgeon to the first, or sentinel, lymph node or nodes in the system draining the breast. If the sentinel lymph node is clear of disease, then the cancer has probably not spread beyond the breast.
Lymphedema can occur for different reasons. In patients who have been treated for breast cancer, it can occur due to obstruction of the lymphatic flow at the axilla. Lymph nodes may have been removed or blockage occurred due to scarring. It usually affects the arm and hand but it can also occur in the breast, underarm, chest, or back. In severe cases, the entire arm may be very swollen from the shoulder to the finger tips.
Signs and symptoms of lymphedema after breast cancer treatment may include:
- Swelling in arms, hands, fingers, shoulders or chest
- A feeling of heaviness or tightness
- Restricted range of motion
- Aching or discomfort in the area
- Decreased flexibility in the hand or wrist
- Hardening and thickening of the skin on your arm
Once swelling develops, the affected arm will be more susceptible to more problems with swelling. Lymphedema may develop in patients who have had lymph nodes removed, had cancer involvement of the lymph nodes, or had radiation to the axilla. Patients should take care to protect that arm and hand from infection. Avoid cuts, scratches and burns to that extremity and take care to clean any injuries.
Traditionally, treatment has focused on controlling any pain and reducing swelling. This can be done with light exercise, massage and compression garments. Patients may also benefit from physical therapy.
At PRMA Plastic Surgery we offer two surgical treatment options for lymphedema of the upper extremity.
The first is Vascularized Lymph Node Transfer surgery. This procedure involves transplanting healthy lymph nodes from another part of the body (most commonly the groin) to the underarm. These lymph nodes can be transplanted to the armpit at the same time as DIEP flap breast reconstruction, or as a stand-alone procedure. Both methods can permanently reduce or even eliminate lymphedema in some cases.
The second is Lymphaticovenous Anastomosis (LVA). LVA is one of the newest methods used to treat lymphedema. LVA’s require specialized training as well as special instruments. During the procedure lymphatic channels are connected to nearby veins under a microscope. By altering the route for lymphatic fluid to return to the heart, lymphedema can be improved.
Although there is no cure for lymphedema, treatment can significantly improve symptoms and quality of life!