Lymphedema is the swelling of the soft tissues caused by a build-up of lymph fluid. Lymph is a thin, clear fluid that circulates through your body to remove waste, bacteria, and other substances from tissues. Edema is the medical term for swelling.
Depending on the type of surgery and other treatments a person has, it’s possible for lymphedema to occur in the arm, hand, breast, trunk, or abdomen. The swelling can be accompanied by pain, tightness, numbness, and sometimes infection. Lymphedema can happen days, months, or years after breast cancer treatment and can be temporary or ongoing. Because lymphedema can be misdiagnosed or overlooked in mild cases, it’s difficult to know exactly how many women are affected. Experts estimate that 20-30% of women will have some type of lymphedema after breast cancer surgery.
A study suggests lifestyle changes aimed at getting to and maintaining a healthy weight as well as promoting the flow of lymph fluid can help reduce lymphedema risk in women who have been treated for breast cancer.
The research was published in the May 2014 issue of Annals of Surgical Oncology. Read the abstract of “Proactive Approach to Lymphedema Risk Reduction: A Prospective Study.”
People who are overweight or obese are more likely to develop lymphedema after breast cancer treatment. Overweight is defined as a body mass index (BMI) of 25-29.9, obese as a BMI of 30 or greater. For example, a 5’5” woman weighing between 150 and 179 is considered overweight; the same height woman weighing 180 pounds or more is considered obese.
When your body has extra fat, that fat tissue requires more blood vessels to bring it oxygen and nutrients. As a result, any areas of the body with extra fat also have more fluid to get rid of. If your lymphatic system can’t handle the amount of fluid coming out of your arms or upper body, lymphedema can result.
If your body can’t move lymph fluid as it should, you also may have a higher risk of lymphedema. If you have an injury or infection that leads to inflammation of your tissues, it makes your lymphatic system work harder. When an area of the body is inflamed, blood flow increases and so does the fluid load. For example, an infected cut is usually swollen and red and pus may form. If your lymphatic system can’t keep up with this extra fluid, it can trigger lymphedema.
To help women proactively reduce their risk of lymphedema after being treated for breast cancer, a team of researchers at New York University developed a program called The Optimal Lymph Flow that teaches women self-care strategies, including:
- shoulder mobility exercises
- muscle-tightening deep breathing
- muscle-tightening pumping exercises
- large muscle exercises to promote lymph flow and drainage (walking, dancing, swimming, yoga, tai chi)
The Optimal Lymph Flow program also offers nutritional education and encourages women to follow a balanced, portion-appropriate diet.
To see how well the program worked, the researchers recruited 134 women diagnosed with breast cancer to go through the program and be part of a pilot study.
Nearly 60% of the women had axillary lymph node surgery; about 40% had sentinel lymph node biopsy. Compared to the women who had sentinel node biopsy, more women in the axillary lymph node surgery group had a mastectomy and chemotherapy. Still, both groups were similar in terms of body weight and BMI.
The researchers followed the women for 1 year after surgery.
The women’s arm volumes were measured with an infrared perometer (an electrical optic device that offers very precise measurements). The women’s BMI were calculated using a bioimpedance device (a scale that sends a very small bit of electric current through the body which measures total body water, which is then used to estimate body fat and fat-free body mass).
The women’s arm volume and BMI were calculated four times:
- before breast cancer surgery
- 2 weeks after surgery
- 6 months after surgery
- 12 months after surgery
For this study, the researchers said a woman had lymphedema if she had a 10% or greater increase in arm volume on the same side as the breast cancer compared to the arm’s volume before surgery and compared to changes in the arm on the opposite side.
After 1 year, the researchers found:
- 97% of the women in the study had either the same arm volume as they did before surgery or had a smaller arm volume
- almost 90% of the women said the program helped them to understand how to reduce their risk of lymphedema and also eased their fears of developing lymphedema
None of the women in the study reported any injury or discomfort linked to The Optimal Lymph Flow program.
While the results of this study are very encouraging and positive, this was a very small pilot study. A larger, randomized study will be done to confirm the program offers benefits. A randomized study means that half the women in the study would be randomly assigned to complete The Optimal Lymph Flow program and half would be randomly assigned to another type of lymphedema education.
If you’re scheduled to have breast cancer surgery, be sure to ask your doctor about your risk of lymphedema and any steps you can take to lower that risk. If you’ve already had surgery and have been diagnosed with lymphedema, it’s a good idea to ask for a referral to a lymphedema therapist who has experience treating women with breast cancer.
You can learn much more about how lymphedema happens, the risk factors for lymphedema, steps you can take to minimize that risk, and lymphedema treatments in the Breastcancer.org Lymphedema section.
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