Bandaging is a mainstay of treatment for stage 2 and stage 3 lymphedema (moderate to severe lymphedema). Bandaging involves creating a soft cast on the arm or upper body by wrapping with multiple layers. This is a main component of the larger treatment regimen called complete decongestive therapy, or CDT, and many research studies have demonstrated the effectiveness of CDT. While there aren’t many studies that focus just on bandaging, the small amount of research available suggests that bandaging can reduce arm volume.
At first, your lymphedema therapist should do the bandaging for you while teaching you the right technique. Some therapists provide an instructional DVD or written directions to guide you. The process starts with an inner liner made of stocking-like fabric or gauze, also known as a stockinette. The liner would be placed over the arm and hand after moisturizing the skin with a gentle lotion such as Eucerin or Curel. “Try to avoid lotions with anything that could irritate the skin, such as perfumes or dyes,” advises Nicole Stout, MPT, CLT-LANA, Senior Rehabilitative Services Practice Leader at Kaiser Permanente, Mid Atlantic Region. “If the lotion is pink and flower-scented, for example, I tell my patients to save that for another time.”
In most cases, padding made of polyester, cotton, or foam would be placed over the stockinette, followed by multiple overlapping layers of short-stretch bandages. Short-stretch bandages look like the Ace bandages you might get at the drugstore, but they’re much less stretchy. Generally, there would be more layers further down on the limb and fewer layers higher up, creating graded pressure that helps fluid move up and out of the arm. The bandages should feel snug but not tight.
Bandaging is also an option for lymphedema of the chest or trunk, as short-stretch bandages come in all sizes. Check with your lymphedema therapist.
Breastcancer.org does not recommend trying any of the above on your own. Attempting to create your own plan and bandage the affected area yourself with no initial supervision can make lymphedema worse. Always work with a well-qualified lymphedema specialist.
Bandaging is a reductive therapy, meaning it makes the limb smaller. When your arm is bandaged, your muscles are “held in” by the multi-layer soft cast every time you use your arm. This is known as working pressure. When you do any prescribed exercises with the bandages on, or simply use your arm as for normal activities, this working pressure creates an internal pumping action that moves fluid out of the tissues and into vessels of the lymphatic system. The bandage cast helps prevent fluid from flowing back into the limb, and it also softens the tissue under the skin. This is why bandages are an important treatment for lymphedema that is causing moderate to severe swelling and/or soft tissue changes.
Bandaging vs. compression sleeves
Bandages work differently than compression sleeves, which support the flow of lymph in the right direction but don’t decongest (move fluid out of) the limb. Sleeves apply what’s known as resting pressure, meaning that the pressure is higher when the arm is at rest. When you move your arm, the elastic fabric moves right along with it, which actually reduces the amount of pressure. A compression sleeve may be enough for mild lymphedema, but more advanced cases need the help of bandaging before a compression sleeve can be used. Bandaging works by reducing limb volume.
Timing and cost
Although lymphedema treatment plans vary, bandaging is usually done every day for a few to several weeks as part of CDT. With CDT, the bandages are worn day and night for a few weeks to a month, and removed only for bathing or treatment sessions with your lymphedema therapist. After CDT ends, you may be able to switch to a compression sleeve, or you may need to keep bandaging frequently or from time to time. Your therapist can help you determine what makes the most sense, depending on how the lymphedema responds.
If bandaging is part of your treatment plan, you’ll get the supplies directly from your lymphedema therapist or a medical supply company. It’s generally recommended that you get two sets of bandages so you can alternate them for washing. The cost can range from $100 to $150 and isn’t typically covered by insurance — but be sure to check with your plan.
Some common brands of short-stretch bandages include:
Daily bandaging takes a great deal of time and energy. It can be a real pain! It’s also not fun to walk around with a soft cast on your arm all day every day. But when done correctly, bandaging can be quite effective in reducing the size of your limb (or other affected area). If you’re having trouble keeping up with your bandaging regimen, talk to your lymphedema therapist. He or she may have suggestions.