Decongestive Therapy Helps Remove More Fluid from Arm with Lymphedema Than Compression Sleeve

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Lymphedema is swelling of the arm, hand, or chest wall caused by a build up of lymph fluid in those tissues after breast cancer surgery. (Edema is the medical term for swelling.)

Many women wear elastic compression sleeves and/or gloves to gently compress the tissues and move excess fluid out of the arm area and ease lymphedema. Another treatment for lymphedema is decongestive therapy. During decongestive therapy, a specially trained therapist gently massages the skin and soft tissues affected by lymphedema. The affected arm usually is massaged for an hour once a day, 3 to 5 days a week, and then bandaged for the other 23 hours.

A study found that women with lymphedema who had decongestive therapy had slightly less excess fluid in their arms compared to women who only wore a compression sleeve. Decongestive therapy seemed to offer more benefits for women who had had lymphedema for more than a year.

Between 5% and 25% of women develop some level of lymphedema after breast cancer surgery. Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues near the surgical site. Radiation therapy and chemotherapy can increase the risk of lymphedema.

Decongestive therapy also is known as manual lymphatic drainage or complex decongestive physiotherapy and is typically done once a day, 3 to 5 days a week, for several weeks depending on how swollen the arm or hand is. At the end of every massage session, the therapist wraps the arm or hand in customized bandages to keep excess fluid out of the arm and shape the arm to look less swollen. The therapist usually prescribes exercises to do while wearing the bandages.

Decongestive therapy is very different from traditional massage therapy, which focuses on muscles and deep tissues and can be quite forceful. Traditional massage therapy can sometimes make lymphedema worse rather than better.

In this study, 95 women who developed lymphedema after breast cancer surgery were randomly assigned to receive either decongestive therapy or wear a compression sleeve to treat the lymphedema. The women's affected arms were about 27% larger than their unaffected arms.

The 56 women treated with decongestive therapy had an hour-long massage once a day for 4 weeks. After the massage, they wore gauze and bandages on the affected arm for the other 23 hours. After the 4 weeks of decongestive therapy, the women wore compression sleeves and gloves 12 hours a day. The women also received general advice on skin care, exercise, and diet.

The other 39 women wore compression sleeves and gloves 12 hours a day. They also received general advice on skin care, exercise, and diet.

A year after lymphedema treatment ended, the arms of the women who received decongestive therapy were 29.3% smaller, compared a 22.6% reduction in arm size for women who used only compression sleeves and gloves. This difference in arm size was small enough (less than 7%) that it could have been due to chance and not because of the different treatments.

Still, when the researchers looked at the actual amount of fluid removed (rather than the percentage reduction in arm size), they said the difference between the two treatments was important. On average, the women who received decongestive therapy had more than 8 ounces of fluid removed from their arms, compared to less than 5 ounces for women who used only compression sleeves and gloves.

For some women who develop lymphedema, the swelling is mild and goes away over time with treatment. For other women, the swelling is severe and can be an ongoing problem. If you've developed symptoms of lymphedema after surgery, whether mild or severe, you may want to consider decongestive therapy. In addition to reducing the amount of excess fluid, many women find that decongestive therapy relieves some of the pain and stiffness associated with lymphedema. Many therapists feel that decongestive therapy helps ease lymphedema. Always check with your doctor to make sure that decongestive therapy makes sense for your specific situation.

You can learn more about the risks for lymphedema, steps you can take to minimize that risk, and tips for managing lymphedema in the Breastcancer.org Lymphedema section.

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