Reducing the Risk of Lymphedema and Flare-Ups
Breast cancer surgery and other treatments, such as radiation, can increase lymphedema risk. If you’ve been diagnosed with breast cancer, the best time to reduce your risk of developing lymphedema is before you have surgery or begin other treatments. But it doesn’t always work out that way.
When people are first diagnosed with breast cancer, it’s natural for everyone to focus on discussing the cancer’s characteristics and possible treatments. It’s easy to lose sight of possible side effects like lymphedema.
But even if you’re already receiving breast cancer treatment, there are steps you can take to reduce lymphedema risk. And if you’ve already been diagnosed with lymphedema, there are also steps you can take to keep it from getting worse.
“Part of what makes lymphedema so frustrating and complex is that one woman can have two lymph nodes removed and get it, while another can have 30 removed and never get it,” says Kathryn Schmitz, PhD, MPH, a professor at the University of Pennsylvania’s School of Medicine. “Why? We don’t fully understand that yet.”
Reducing lymphedema risk before surgery
Here are some ways to reduce lymphedema risk before you have surgery. Ask your doctor or lymphedema specialist if these options make sense for you.
Ask your doctor or lymphedema specialist whether it makes sense for you to limit alcohol consumption. If you smoke, you may want to ask about smoking cessation programs.
If you’re preparing for breast cancer surgery, ask your surgeon if it’s possible to have a sentinel lymph node biopsy (SLNB) instead of an axillary lymph node dissection (ALND). Surgeons remove fewer lymph nodes during a sentinel lymph node biopsy than they do during axillary lymph node dissection. Lymphedema risk is higher when more underarm lymph nodes are removed.
In certain cases where breast cancer has spread into multiple lymph nodes, surgeons may have to perform an axillary lymph node dissection to reduce recurrence risk (the cancer coming back) or metastasis (when breast cancer spreads to other parts of the body). Reducing those risks is more important than reducing the risk of lymphedema.
Learn more about lymph node removal.
Slight swelling in the arm can be difficult to notice. Before breast cancer surgery, ask your cancer care team if they can measure around your arms (the circumference). Usually, marks are made from a point on your hands and up your arms at regular intervals and each of those intervals gets measured. After you have surgery, your doctor or lymphedema specialist can measure the same points in both arms to keep track of any swelling.
If you take your own measurements, you may need some help so the marks along both your arms match. Be sure to use a paper or plastic tape measure or even a flexible vinyl spring-loaded tape measure. Measuring both arms is important so you can easily tell whether there are any size differences.
A lymphedema specialist can teach you which arm stretches and exercises you can do before surgery and in the weeks after — that way you don’t have to learn them when you’re recovering from surgery. Some experts recommend meeting with a lymphedema specialist before surgery, one month after surgery, every three months for the first year, and then every six months for up to five years after surgery. Of course, you should see your lymphedema specialist any time you notice any symptoms.
“Learning the exercises and ways to reduce lymphedema risk before surgery is a good idea,” says Linda T. Miller, PT, DPT, CLT, a curriculum developer and an instructor at Recovery in Motion. “That way you don’t have to learn them while you’re in pain or recovering.”
Reducing the risk of lymphedema and flare-ups after surgery
After breast cancer surgery, you can ask to see a physical therapist before you’re discharged from the hospital — especially if you don’t already have a lymphedema specialist.
You may be encouraged to elevate the affected arm a few times a day for the first 24 to 48 hours after surgery. Your physical therapist or lymphedema specialist can show you how to prop up your arm on pillows correctly and let you know when it’s safe to start:
stretching your arm to work the underarm area where the lymph nodes are concentrated
lifting your arm shoulder height or overhead
doing gentle exercises designed to restore full range of motion to the arm and shoulder to get the lymph flowing again, ease swelling, and increase flexibility
Always be aware of how much stress you place on your hand, arm, and upper body, even if it’s been years since you had breast cancer surgery.
“Now you have to pay attention to stresses you are putting on your arm, such as sudden changes in temperature, the amount you are lifting, cuts, sunburns — anything that would tax this area of the body,” says Dr. Schmitz. “Ask yourself: What is my arm stress-o-meter for the day? How many hours were my arm and hand in hot soapy water washing dishes? How many hours was I baking and cleaning? Lifting kids? Using harsh cleaners? Was I out in the hot sun that day?”
Here are a few guidelines that can help you minimize these types of stresses:
Wear protective gloves for activities that could stress your hand and arm or injure your skin. These include rubber gloves for cleaning or washing dishes; gardening gloves for planting, pruning, and outdoor chores; oven mitts for cooking and grilling; and even chef’s gloves when using sharp knives or a grater. Try to find gloves that extend up the arm. These protective measures can help reduce the risk of infection.
Learn more about lymphedema and infection.
Use gentle moisturizing soap and gentle lotions daily to keep your skin supple and to prevent cracking. Push your nail cuticles back after you shower and keep them moisturized. If you get manicures, avoid anything that cuts or overstresses the skin around your nails. Artificial nails can also become infection sites if not fitted or maintained properly.
If you shave your underarms, use a cream hair remover labeled for sensitive skin instead of shaving. It’s a good idea to test any hair-removing creams on a small patch of skin first. If you prefer a razor, you may want to try an electric one as long as you still take care to avoid any skin irritation or nicks.
Use sunscreen with an SPF of 30 or higher to avoid sunburn. Use insect repellents that don’t dry out the skin or contain harsh chemical ingredients.
Avoid taking hot showers, soaking in hot tubs, and using heating pads or hot compresses on the affected arm, neck, shoulder, or back. It’s also a good idea to avoid other heat-producing treatments provided by physical, occupational, or massage therapists, such as ultrasound, whirlpool, and deep tissue massage. The heat generated by these treatments causes more blood and extra lymph to flow to the affected area.
Pressure from a heavy shoulder bag or tight-fitting clothing or jewelry can also restrict the flow of lymph out of the hand, arm, or chest. Avoid wearing bras, camisoles, or tops that fit too tightly or clothing with tight sleeves. It’s also a good idea to avoid wearing watches, bracelets, or rings on the affected hand and arm.
Take frequent breaks when you are doing heavy chores such as scrubbing, mopping, or raking, which involves repetitive use of the arm and upper body. Sudden intense exercise or lifting heavy things before your arm is ready can strain or pull the muscle and make your body’s tissues produce more lymph. Keep lymph flowing by doing the stretches your doctor or lymphedema specialist showed you during these breaks. Stop if your arm feels tired, heavy, or achy.
Your lymphedema specialist can tailor an exercise program to strengthen your arm and upper body that’s right for you. Avoid doing too much too soon with the affected arm. Keep an eye on how the affected area looks and feels so you can make adjustments to your routine as needed.
Learn more about lymphedema exercises and tips.
Healthy and strong bodies come in all shapes and sizes, including large. Not everyone who is plus size develops lymphedema. But people who carry extra weight have a higher risk of developing the condition. If you are plus size, consider asking your doctor whether weight management can help reduce lymphedema risk for you.
Some weight management techniques include gentle stretches and safe exercises that also promote efficient blood circulation and lymph flow. If you would like to lose weight, you can also ask a nutritionist to advise you on healthy and balanced diets. Many hospitals and cancer centers have nutritionists on staff.
Early signs of lymphedema can be very subtle. Your arm, hand, or upper body may look or feel a little different. But these changes might seem like they’re no big deal because they come and go at first. As soon as you spot even minor signs and symptoms of lymphedema, let your doctor and lymphedema specialist know.
Lymphedema medical alert bracelets are available for purchase through the National Lymphedema Network. You can also wear a G-sleeve — a flexible garment worn on the forearm and clearly labeled no blood draws, no blood pressure, no IVs — to doctor appointments or during hospital stays. If both your hands and arms are affected, you may want to ask if it’s possible to draw blood or take your blood pressure from another area of your body.
It’s possible for lymphedema to develop even if you follow all the recommendations to reduce your risk. For example, other health conditions such as diabetes, high blood pressure, congestive heart failure, or other cardiovascular conditions can affect lymphedema risk. But following your doctor and lymphedema specialist’s advice can still help to ease symptoms and prevent lymphedema from progressing to advanced stages.
“If at all possible, it’s worth seeing a physical medicine doctor or another expert who can show you how to use your body in the safest and fullest way again,” explains Marisa Weiss, MD, chief medical officer of Breastcancer.org. “Things that you did automatically before — carrying groceries, yoga, tennis — now need to be done with some caution and care until you know how your body will handle them again. You want to work with someone who knows how your body moves and grooves and can help you gradually work back up to where you were before.”
— Last updated on August 7, 2025 at 9:01 PM