Lymphedema
One of the possible side effects of breast cancer surgery and other treatments, such as radiation, is lymphedema.
What is lymphedema?
Lymphedema is abnormal swelling that develops when the lymphatic system is damaged or overwhelmed and can’t clear lymph fluid fast enough, causing it to build up. Lymph is a thin, clear fluid that circulates through the lymphatic system removing waste, bacteria, and other substances from the body’s tissues. Edema is the buildup of excess fluid.
In people who’ve had treatment for breast cancer, lymphedema can develop in the arm or hand of the affected side, although it may also develop in the breast, chest, armpit, trunk, or back.
There’s no way to know for sure whether you might develop lymphedema after breast cancer treatment, but you can help yourself by:
knowing your risk factors
taking steps to reduce that risk
being aware of early signs and symptoms
Signs and symptoms of lymphedema
Lymphedema can develop gradually and tends to progress over time. You may feel an unusual sensation — such as tingling or numbness — that comes and goes before you notice any visible swelling.
Symptoms of lymphedema after breast cancer treatment can include:
changes in skin texture or appearance, such as tightness, itching, rash, redness, or hardening
achiness, tingling, discomfort, or increased warmth in the arm, hand, breast, chest, or underarm
a sensation of fullness or heaviness in the arm, hand, breast, chest, or underarm
tightness or decreased flexibility in nearby joints, such as the shoulder, hand, or wrist
bursting or shooting pain sensations, or pins and needles
tenderness in the elbow
slight puffiness or swelling in your arm, hand, breast, or chest with a temporary indentation of the skin when you press on it with your finger (this is called pitting edema)
veins or tendons in the hand that are harder to see, knuckles that look less pronounced, or once-wrinkled skin that looks smoother
fever or flu-like symptoms
If you ever have sudden severe swelling — meaning that the affected area seems to blow up to a larger size within a day or two — see your doctor right away. It could be signs of an infection, a blood clot (also known as deep vein thrombosis), or cancer recurrence that is affecting the lymphatic system.
How the lymphatic system works
Knowing how the lymphatic system works can help you understand why lymphedema develops. The lymphatic system and cardiovascular system work together to maintain the balance of fluid in your body. Both systems supply nutrients to your body’s tissues and organs and remove waste products.
Learn more about how the lymphatic system works.
Risk factors for lymphedema
Anything that might damage the lymphatic vessels under your skin — and interrupt lymph flow — can increase the risk of developing lymphedema or having a flare-up.
An extensive surgical procedure, such as mastectomy, increases the risk of lymphedema more than lumpectomy. Experts also believe that having multiple chest surgeries — either to treat breast cancer or another condition — can disrupt the lymphatic system and increase the risk of lymphedema.
Lymph node removal during breast cancer surgery also increases lymphedema risk, and the risk increases as more lymph nodes are removed. Between 5% and 17% of people who have sentinel lymph node biopsies — in which surgeons remove one to three lymph nodes — develop lymphedema, according to the National Cancer Institute. For people who have axillary lymph node dissection — in which 10 or more lymph nodes are removed — the percentage jumps to between 20% and 53%.
Learn more about lymph node removal.
If you’ve been diagnosed with lymphedema and plan to have any type of surgery, including breast reconstruction surgery, ask your surgeon and cancer care team about monitoring for lymphedema flare-ups and advice on how to keep excess lymph and fluid from building up in the area.
Radiation treatments can affect the lymphatic system. Scar tissue from radiation therapy may press on or narrow the lymph vessels and nodes that remain after breast cancer surgery. This damage interferes with the flow of lymph out of the arm and upper body.
The needle used to place an IV for intravenous chemotherapy may increase lymphedema risk if it’s placed in the arm on the same side you had lymph nodes removed. Ask your cancer care team to place the IV for chemotherapy on the opposite arm. If your surgeon removed lymph nodes from both sides, you may want to ask your oncologist about using a chest port.
People who carry extra weight have an increased risk of developing lymphedema after breast cancer treatment. Sometimes, extra fat can put pressure on lymph nodes and vessels, and that extra pressure may affect lymph flow and drainage.
Sometimes, an injury or infection can lead to lymphedema or a lymphedema flare-up — especially if you have fewer lymph nodes as a result of breast cancer surgery.
When we injure ourselves or get an infection, the body’s tissues can get inflamed. This makes the lymphatic system work harder because blood flow and lymph fluid increase. If your lymphatic system can’t keep up with this increased flow, you can get lymphedema.
Overusing a limb can also lead to lymphedema. For example, the heart pumps more blood through the arm if you’re using it more than you usually do. The extra blood and fluid can overwhelm the lymphatic system and lead to lymphedema symptoms.
Research suggests that airplane flight itself is unlikely to increase lymphedema risk. But some experts recommend that people who’ve already been diagnosed with lymphedema talk with their doctors about taking precautions to keep lymphedema symptoms and flare-ups at bay.
Air pressure is lower at high altitudes. Even though airplane cabins are pressurized for our comfort and safety, the pressure is still lower than it is on the ground. The theory is that less pressure on the upper body and limbs could slow down the flow of lymph, leading to an increased risk of pooling in the tissues, especially during long flights. Another possible factor is the many changes in pressure that people experience when they have two or three connecting flights.
Other travel-related risk factors include injuring yourself from lifting very heavy suitcases and keeping your arm and upper body in one position for too long.
Reducing the risk of lymphedema and flare-ups
Taking steps to reduce lymphedema risk before breast cancer surgery is the best way of trying to prevent lymphedema from developing at all. But even if you’ve already had surgery — and even if you’ve been diagnosed with lymphedema — there are still steps you can take to lower your risk or keep it from getting worse.
Learn more about reducing the risk of lymphedema and flare-ups.
Finding a lymphedema specialist
A lymphedema specialist is a healthcare professional who diagnoses, treats, and helps to manage lymphedema symptoms. It’s best to find a lymphedema specialist before you begin breast cancer treatment, but it’s never too late to find one.
Learn more about finding a lymphedema specialist.
Diagnosing lymphedema
The criteria for diagnosing lymphedema can vary by specialist. For example, doctors look at the size and volume measurements of the affected area. But some experts recommend that doctors also consider how the affected area looks. For example, someone might have subtle hand swelling or pitting of the skin.
When diagnosing lymphedema, doctors are likely to use the stages determined by the International Society of Lymphology.
Although lymphedema and axillary web syndrome (or cording) are both linked to the removal of lymph nodes, they are different:
Lymphedema is a buildup of lymph fluid in the fatty tissues just under the skin that can lead to swelling.
Axillary web syndrome, or cording, is a side effect that may develop after lymph node removal surgery. Scarring or inflammation of lymph or blood vessels causes a ropelike structure to develop under the skin of your underarm and inner arm.
Some experts believe that axillary web syndrome may increase the risk for lymphedema to develop later on, but more research is needed.
Lymphedema stages
Lymphedema usually progresses through a series of four stages that range in severity from stage 0 to stage 3. Stage 0 and stage 1 lymphedema are often reversible, so it’s important to see your doctor as soon as you notice signs and symptoms.
Learn more about the lymphedema stages.
Lymphedema treatments
There are various surgical and non-surgical treatments for lymphedema. If left untreated, lymphedema can worsen and cause severe swelling and permanent changes to the tissues under the skin, such as thickening and scarring.
Learn more about lymphedema treatments.
Lymphedema and your job
When you return to work after breast cancer surgery and other treatment, it’s important to protect yourself from injuries or exposure to harsh substances by wearing gloves, for example. You should also take precautions if your job requires heavy use of your arm, hand, or upper body — including repetitive or intense lifting, reaching, pushing, or pulling.
One key way to prepare yourself to return to work safely is by working with your doctor or lymphedema specialist to strengthen the affected area gradually and condition yourself for work-related tasks. It’s never a good idea to jump right back into heavy arm and upper body use too soon after surgery. Everybody is different, but it can take anywhere from six weeks to two months to get back in condition.
Give your employer a note from your doctor or lymphedema specialist and explain that:
you’ve been diagnosed with lymphedema
lymphedema can be a complication of breast cancer treatment
you may need a temporary change in your role while you build up strength in the affected area
You may also be eligible to take leave while you recover, either under the Family Medical Leave Act or because your employer offers short-term disability insurance.
If your lymphedema specialist recommends you wear a compression sleeve or garment as a precaution, your co-workers might be curious and ask you about it. How you respond and how much you feel comfortable sharing with them is entirely up to you.
— Last updated on August 7, 2025 at 8:49 PM
