comscoreWearing Compression Sleeves Preventively May Reduce Lymphedema Risk After Breast Cancer Surgery

Wearing Compression Sleeves Preventively May Reduce Lymphedema Risk After Breast Cancer Surgery

Wearing a compression sleeve preventively reduced the risk of arm swelling in women at high risk for lymphedema.
Mar 18, 2022.
 

Wearing a compression sleeve preventively reduced the risk of arm swelling in women who had axillary lymph node dissection as part of breast cancer surgery and were at high risk for lymphedema, according to a small Indian study.

The research was published online on Feb. 2, 2022, by the Journal of Clinical Oncology. Read the abstract of “Prophylactic Use of Compression Sleeves
Reduces the Incidence of Arm Swelling in Women at High Risk of Breast
Cancer-Related Lymphedema: A Randomized Controlled Trial.”

 

About lymphedema

Lymphedema is abnormal swelling that can develop in the arm, hand, breast, or torso as a side effect of breast cancer surgery, radiation therapy, or both. The condition can develop months or even years after treatment ends.

Breast cancer surgery and radiation therapy can cut off or damage some of the remaining lymph nodes and lymph channels in the affected area, which can keep lymph fluid from flowing through the body easily. Over time, lymph fluid can overwhelm these remaining channels and build up in the body’s tissues near the treated area.

Today, many experts estimate that about 20% to 30% of women diagnosed with breast cancer develop lymphedema.

Risk factors for lymphedema include:

  • axillary lymph node dissection

  • radiation therapy

  • having multiple surgeries in the chest area

  • being overweight or obese

Still, axillary lymph node dissection is the main risk factor for lymphedema.

Treatments such as compression sleeves and bandages, pumps, exercises, and manual lymphatic drainage can help lymph flow out of the area affected by lymphedema.

 

About axillary lymph node dissection

Surgeons usually perform axillary lymph node dissection at the same time as mastectomy or lumpectomy as part of early-stage breast cancer treatment. A surgeon removes five or more lymph nodes in the armpit area on the same side as the breast cancer. A pathologist then examines the lymph nodes to figure out if there are any cancer cells in them.

If cancer cells are present in the removed lymph nodes, there is a higher risk of the breast cancer coming back — called recurrence by doctors.

When a pathology report shows cancer cells in the lymph nodes, doctors recommend more treatment after surgery, such as radiation therapy, chemotherapy, and possibly targeted therapy.

 

About the study

Doctors don’t commonly recommend wearing a compression sleeve preventively, before lymphedema develops. In this study, the researchers looked at women who had breast cancer surgery and axillary lymph node dissection to see if wearing a sleeve preventively reduced arm swelling in the first year after the surgery.

The study included 301 women who had breast cancer surgery between 2018 and 2020 at Tata Memorial Hospital in Mumbai, India:

  • about 62% of the women had mastectomy and 38% had lumpectomy

  • none of the women had double mastectomy

  • about 67.5% were considered obese

  • about half the women had more than 18 lymph nodes removed and half had fewer nodes removed

  • about 52.5% had chemotherapy before and after surgery

  • about 92.5% had radiation therapy after surgery

The day after surgery, the researchers randomly assigned the women to one of two groups:

  • 149 women received the usual post-surgery care for lymphedema prevention. This included attending one group education session on arm, skin, and drain care, as well as how to identify the signs and symptoms of lymphedema. The women also learned how to do daily shoulder exercises and received a booklet outlining all the information presented in the session. The researchers also asked anyone who noticed signs of lymphedema to contact them. This was the control group.

  • 152 women received two compression sleeves in addition to the usual post-surgery care for lymphedema prevention. The women were asked to wear a sleeve on the side affected by breast cancer for at least eight hours every day while they were awake. The group was told to start on the first day after surgery and continue wearing the sleeve for three months after completing chemotherapy and radiation. The women also were asked to keep a written record of how long they wore the sleeve each day. Anyone who didn’t wear the sleeve for at least eight hours was asked to explain why. The women received a booklet with instructions on how to put on and take off the sleeve and how to wash it. This was the intervention group.

The researchers measured the women’s arms four times:

  • before breast cancer surgery

  • when stitches were removed, two to four weeks after surgery

  • five to seven months after surgery

  • 11 to 13 months after surgery

The researchers used bioimpedance spectroscopy (BIS) to measure the women’s arm volume. BIS involves passing an extremely low-strength electrical current through the area and measuring how the current’s flow is slowed by the body’s fluid.

The women filled out a breast cancer-related quality of life survey before surgery and at each follow-up doctor’s visit, except for when the stitches were removed.

Overall, the results showed that women who wore a compression sleeve were less likely to have arm swelling than women who didn’t. Any arm swelling in women who wore the sleeve developed later than it did in women who didn’t wear a sleeve. One year after surgery:

  • 42% of women who wore a compression sleeve had arm swelling

  • 52% of women who didn’t wear a compression sleeve had arm swelling

The survey results showed no difference in breast cancer-related quality of life between the two groups of women.

“For women at high risk of [breast cancer-related lymphedema], the prophylactic use of compression sleeves in addition to usual care reduced and delayed the incidence of arm swelling compared with those in the control group,” the researchers wrote. “In addition, wearing compression sleeves did not appear to negatively affect the women’s self-reported general health, physical functioning, and arm or breast symptoms.”

 

What this means for you

The results of this study are interesting. Still, there are several things to keep in mind:

  • This study was very small and involved women treated at a single institution. More research is necessary to show whether or not wearing compression sleeves preventively before any lymphedema develops should become the standard of care.

  • It’s not clear whether not having arm swelling in the first year after surgery means there is a lower risk of lymphedema more than one year after surgery.

  • Sentinel lymph node dissection is the current standard of care for many, but not all, people diagnosed with early-stage breast cancer. Surgeons remove up to three nodes that are closest to the breast cancer. The risk of lymphedema is lower with sentinel lymph node dissection since surgeons remove fewer nodes than they do with axillary lymph node dissection.

If you’ve been diagnosed with breast cancer, you can’t control how your body responds to any changes in your lymphatic system. But there are steps you can take to reduce your risk of lymphedema before and after breast cancer surgery, including:

  • having your arms measured before surgery so you can tell if there is any change in arm size

  • scheduling an appointment with a lymphedema specialist before surgery to measure your arms, asses your strength, and teach you exercises that improve range of motion and flexibility after surgery

  • learning to recognize the signs and symptoms of lymphedema

You also can ask a lymphedema specialist if wearing a compression sleeve preventively makes sense for your unique situation.

Learn more about Lymphedema.

Written by: Jamie DePolo, senior editor

— Last updated on April 5, 2022, 4:42 PM

Reviewed by 1 medical adviser
 
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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