Treatments for Lymphedema
There are various surgical and non-surgical treatments for lymphedema. It makes sense to review as many as you can with your lymphedema specialist so can decide which of them may work best for you.
Your lymphedema specialist may recommend arm elevation if your lymphedema is stage 0 or stage 1. Typically, you prop up your arm on pillows on a slant, so that your hand is above your wrist and your elbow is higher than your shoulder. But it’s important to follow your lymphedema specialist’s instructions so you know exactly how to position your arm, how often throughout the day, and for how long.
Compression sleeves and garments
Compression sleeves and garments are made of stretchy fabric and apply pressure to the arm, hand, or trunk to help lymph flow.
Examples of compression garments include:
a sleeve for the arm
a fingerless glove or a gauntlet without individual finger openings, often worn with a sleeve
a support bra for the chest
a vest for the entire trunk
There are daytime compression sleeves and nighttime compression sleeves that are either ready-to-wear (off-the-shelf) or custom-made. Ready-to-wear sleeves are available in different sizes and colors. Some daytime sleeves also come with a glove or gauntlet already attached. Custom-made sleeves are tailored to fit your individual measurements.
A daytime sleeve is a tube of strong but still flexible fabric that extends from the wrist almost to the shoulder. The sleeve’s tightness decreases gradually as it extends up the arm, which helps lymph flow up the arm to the underarm (axillary) lymph nodes.
Sleeves apply resting pressure, which means that the pressure is higher when the arm is at rest. There are four pressure levels, which range from low pressure to high pressure and are classified from 1 through 4. The amount of pressure is measured in millimeters of mercury (mmHg) — of how much pressure is exerted by one millimeter of liquid mercury:
class 1 sleeves exert 20 mmHg to 30 mmHg of pressure
class 2 sleeves exert 30 mmHg to 40 mmHg of pressure
class 3, available as custom order, exerts 40 mmHg to 50 mmHg of pressure
class 4, also available as custom order, exerts 50 mmHg to 60 mmHg of pressure
It’s important to know that sleeves can fit differently, depending on the U.S. manufacturer, even if they are from the same class.
Sleeves manufactured in Europe use a slightly different classification system:
class 1 sleeves exert 18 mmHg to 21 mmHg of pressure
class 2 sleeves exert 23 mmHg to 32 mmHg of pressure
class 3 sleeves exert 34 mmHg to 46 mmHg of pressure
class 4 sleeves exert 49 mmHg of pressure
Generally, more severe cases of lymphedema require a class 3 or 4 sleeves, whereas milder cases require class 1 or 2 sleeves. Some manufacturers also offer compression sleeves that exert as little as 15 mmHg to 20 mmHg for very mild cases of lymphedema. Your lymphedema specialist can help you determine the level of pressure that is right for you. It’s also possible that, over time, you may need to move to a higher-pressure or lower-pressure sleeve, depending on your symptoms.
Daytime sleeves can cost anywhere from $50 to $300, although it’s important to know that custom-made sleeves are more expensive than ready-to-wear sleeves.
If daytime compression isn’t enough to control your symptoms, your lymphedema specialist may recommend you wear a compression sleeve at night. Nighttime sleeves are larger and bulkier and fit a little looser than daytime sleeves. Nighttime sleeves are made of foam and padded material and often have outside straps that you can adjust to provide the right amount of compression.
More expensive than daytime sleeves, nighttime sleeves can cost anywhere from $200 to more than $1,000.
It’s important to know that some experts caution against wearing a daytime sleeve when you’re sleeping. The compression may be too high, and you also can hurt your arm if the sleeve twists or bunches up. If you need round-the-clock compression, ask your lymphedema specialist which types of compression sleeves you should wear.
Regardless of whether you get a ready-to-wear or custom-made compression sleeve, it’s important that you get properly fitted by an expert. It’s never a good idea to buy a sleeve online or at a medical supply store. Proper fitting ensures that the sleeve works as it’s supposed to, helping the lymph to move up and out of the hand and arm. Otherwise, the sleeve might be too tight in certain places, which can restrict the flow of lymph and make things worse.
It’s a good idea to purchase your compression sleeves and garments from your lymphedema specialist. You can also ask your specialist to recommend a durable medical equipment company. “Durable medical equipment” refers to medical equipment or supplies that you use at home. If possible, try to buy two sleeves or garments so you can alternate between washings. You also may want to ask your specialist whether you should get a glove or gauntlet as well, especially:
if your hand has experienced even mild symptoms of lymphedema
as a precaution in case your hand is affected once you start wearing the sleeve
It’s also important to know that compression sleeves and garments lose their stretchiness over time, and they need to be replaced every 3 to 6 months. Avoid wearing moisturizer on your arm and hand when you wear your sleeve. Their ingredients can break down the sleeve’s elastic fibers.
Unfortunately, health insurance plans don’t always cover the cost of compression sleeves and garments. If cost is a concern, you may want to ask your lymphedema specialist if other patients have experienced the same thing. It may also help to connect with other people who are experiencing lymphedema in online and in-person support groups.
Lymphedema specialists recommend bandaging for people diagnosed with stage 2 and stage 3 lymphedema, which is moderate to severe.
You wrap multiple layers of bandages around the affected area — which can be the arm, chest, or trunk — to create a soft cast. It may make sense to have your lymphedema specialist bandage you up, so you can learn the correct technique. It’s also a good idea to ask your lymphedema specialist for written instructions and to recommend an instructional video that can help guide you.
Bandaging begins with an inner liner made of stocking-like fabric or gauze, also known as a stockinette. Before putting on the stockinette, lymphedema specialists recommend you moisturize the area 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 Dr. Stout.
Depending on which area of the body is affected, many people need to place padding made of polyester, cotton, or foam over the stockinette, followed by multiple overlapping layers of short-stretch bandages. Short-stretch bandages look like the Ace bandages you can get at the drugstore, but they’re much less stretchy. There are usually more layers at the bottom of the limb and fewer layers the higher up you go. This type of wrapping creates graded pressure that helps lymph flow up and out of the arm. The bandages should feel snug but not tight.
It’s important to know that it’s best to avoid bandaging yourself without your doctor or lymphedema specialist present to guide you — doing so can make lymphedema worse. Always work with a specialist who can bandage you up and give you appropriate instructions that make sense for your unique situation.
Bandaging is considered a reductive therapy, which means it reduces the limb’s volume and makes it smaller. The multi-layer soft cast holds in your muscles every time you use the affected area for what is known as working pressure. When someone with a bandaged arm uses it during routine activities or prescribed exercises, working pressure creates an internal pumping action that moves lymph out of the tissues and into vessels of the lymphatic system. The bandage cast helps prevent lymph from flowing back into the limb, and it also softens the tissue under the skin. Bandaging is especially ideal for people who are experiencing moderate to severe swelling or soft tissue changes.
It’s a good idea to get all your bandaging supplies from your lymphedema specialist or a medical supply company. If possible, try to get two sets of bandages so you can alternate between washings. Costs can range from $100 to $150 and aren’t typically covered by health insurance — but you may want to check with your plan.
Depending on your lymphedema treatment plan, your lymphedema specialist may have you bandage up the affected area every day for several weeks. Daily bandaging can take a great deal of time and effort. If you’re finding your bandaging regimen challenging, you may want to ask your lymphedema specialist to see if you can adjust your treatment plan to better fit your needs.
Foam pads and chip bags
Foam pads and chip bags are sometimes called Schneider pads and Schneider packs, after the lymphedema specialist who first used them. Your lymphedema specialist may recommend foam pads or chip bags if you have pronounced swelling or scarring and hardening of the soft tissue under the skin. Many therapists find that foam pads and chip bags can help break down and soften areas affected by severe lymphedema.
Foam pads come in many different shapes and sizes. Your lymphedema specialist can work with you to make sure you pick the right pad for you needs. Your specialist also can show you how to place the foam pads under your bandages or compression garment. Foam pads apply constant, gentle pressure to any pockets of obvious swelling to help reduce swelling and soften the affected area.
Chip bags are small bags of shredded foam chips layered between two pieces of fabric. Your lymphedema specialist can help you pick chip bags that work best for you and show you how to place them under your bandages or compression garment. Like foam pads, chip bags knead and massage hardened areas to help soften the tissue.
It’s a good idea to check your health insurance plan to see if costs for foam pads or chip bags are covered.
Manual lymphatic drainage
Manual lymphatic drainage (MLD) — sometimes called manual lymphatic therapy — is a gentle massage technique that helps excess lymph flow out of an affected area and back into the lymphatic vessels. MLD is not the same as other traditional forms of massage. Instead of deep kneading or circular movements, the skin is brushed. One session of MLD can take between 20 and 45 minutes.
If your lymphedema specialist recommends MLD as part of your lymphedema treatment plan, it’s a good idea to:
find out how many hours of training in MLD your specialist has
find out how much hands-on experience your specialist has with MLD
ask whether you can speak with other patients who have had MLD with your specialist
Many health insurance plans cover MLD when it’s done during an office visit. But you may want to confirm whether your plan covers this therapy.
If you have MLD during or after radiation treatments, your specialist should avoid any irritated areas on the skin. MLD is considered safe for people diagnosed with metastatic breast cancer (cancer that has spread beyond the breast).
Working the muscles with gentle stretching and range-of-motion exercises can help keep joints flexible and the lymphatic system healthy. When muscles contract, they pump fluid around the body and help the lymphatic system flow more effectively.
According to the National Lymphedema Network’s Position
Statement on Exercise, most women with lymphedema can exercise safely as long as they:
wear compression garments
do not exercise the arm or other affected body part to the point of fatigue
make appropriate modifications to prevent trauma and overuse
Your lymphedema specialist may recommend stretching and exercise, especially if you are at risk for or have been diagnosed with lymphedema. A typical exercise plan may include a combination of:
flexibility and stretching exercises
strength training (especially for people who were active before breast cancer surgery)
aerobic exercise that uses the upper body
Doing too much too soon can cause strain or injury and trigger lymphedema symptoms, so it’s important to closely follow your specialist’s guidance. Lymphedema specialists often recommend you start slowly and then build up.
“Some examples could include making a fist and extending the fingers, doing wrist curls, or gentle punching motions to extend and flex the elbow,” says Dr. Andrea Cheville, a physiatrist at Mayo Clinic.
If it’s possible, it’s a good idea to work with a physical medicine doctor, physical therapist, occupational therapist, nurse, or massage therapist who specializes in lymphedema management and breast cancer rehabilitation. These experts can teach you how to exercise properly so you can exercise safely on your own.
Some people may find it challenging to meet with an expert who can show them how to exercise properly. If this is the case for you, it’s a good idea to talk with your doctor or lymphedema specialist to see if they can recommend any alternative resources. For example, your specialist may recommend a DVD of low-impact exercises called Strength & Courage: Exercises for Breast Cancer Survivors, developed by a breast cancer survivor and health fitness specialist.
At every step of the way, your exercise routine should match your individual needs and fitness level. For example, if you weren’t necessarily active before breast cancer surgery, you may find strength training to be too painful. Your specialist may recommend you stick with low-impact exercises, such as walking, swimming, or tai chi. If you were active before surgery, your specialist may recommend lifting lighter weights, brisk walking, or biking short distances.
Regardless of your exercise routine, it’s important to:
do your gentle stretches as often as your lymphedema specialist prescribes to keep lymph flowing
closely follow your lymphedema’s specialist’s guidance when exercising, including taking breaks as recommended
stop if anything feels painful and let your lymphedema specialist know right away in case you need to adjust your routine
pay close attention to how your arm, hand, and upper body respond to your stretching and exercise routine
If you notice any change in size, shape, tissue, texture, soreness, heaviness, or firmness, it could be a sign that you need to ease up on a particular activity or take a break. It’s important to let your lymphedema specialist know so you can make adjustments and ensure your plan is sensible, realistic, and safe for you.
Many health clubs, gyms, and hospitals offer exercise programs for cancer survivors. It’s important to check out any program you’re considering in advance and to run it by your lymphedema specialist before you join. Even if a program is billed as cancer rehabilitation, it may not necessarily meet the needs of people at risk for lymphedema.
People who are overweight or obese are at higher risk for developing lymphedema. When the body is carrying excess weight, the tissues require more blood vessels. The extra blood vessels create a higher volume of blood and lymph, which can place a greater burden on the remaining lymph nodes and vessels after breast cancer treatment.
The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, has an online calculator you can use to determine your BMI. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or greater is considered obese. But a high BMI doesn’t necessarily indicate high body fatness, especially in people who are muscular. The Centers for Disease Control and Prevention (CDC) point out that BMI calculators make it possible to screen for weight categories that may lead to health problems but do not diagnose a person’s body fat or even health.
Losing excess weight may ease lymphedema symptoms and reduce the risk of breast cancer recurrence. If you are carrying excess weight, you can ask your doctor or lymphedema specialist to recommend safe exercises. It may also be helpful to see a nutritionist for advice on a healthy and balanced diet. Many hospitals and cancer centers have nutritionists on staff.
Self-care refers to everything you can do at home to reduce the risk of lymphedema coming back or getting worse:
wearing your compression sleeve or garment according to your lymphedema specialist’s instructions
keeping your compression sleeves and garments clean so you can get the most wear out of them
protecting the affected area from cuts, injuries, overuse, and extreme temperatures
learning to spot the signs and symptoms of infection
following the treatment plan you created with your lymphedema specialist
It’s important to know that many treatments for lymphedema are safe to do on your own, as long as your lymphedema specialist has given you guidance. But it is safer to see a specialist for more involved treatments, such as manual lymphatic drainage (MLD). Using aggressive massage strokes when attempting MLD on your own can make things worse.
It’s also important to take care of your mental health. Some people feel frustrated by lymphedema flare-ups. Swelling can sometimes invite questions from others that people may prefer not to answer. Support groups and services may be a good source of emotional support. If you’d like to connect with others who’ve been diagnosed with lymphedema, you can ask your lymphedema specialist to recommend groups or services in your area.
Complete decongestive therapy (CDT)
Complete decongestive therapy (CDT), also called complex decongestive therapy, is an intensive program that combines many different treatment approaches, which may include bandaging, compression garments, manual lymphatic drainage, exercise, and self-care.
CDT consists of two phases and is considered the gold standard of treatment for stage 2 and stage 3 lymphedema, which is moderate to severe.
The first phase of CDT is referred to by a number of names, including the reductive phase, the decongestion phase, the intensive phase, and the active phase. Phase I focuses on getting the extra lymph out of the affected area to reduce visible swelling and improve the affected area’s shape and the skin’s condition.
This first phase can last anywhere between 3 and 8 weeks, depending on how long it takes to bring down the swelling and improve any other symptoms. During phase I, you typically see your lymphedema specialist five days a week for sessions that may include MLD, short-stretch compression bandaging (with or without form pads or bag chips), and exercise. You also need to wear the bandages around the clock, removing them only for showering or bathing and MLD sessions.
Your lymphedema specialist keeps track of the affected area’s appearance to see if your phase I sessions have done everything they can to reduce your symptoms and determine whether you are ready for phase II.
Phase II focuses on maintaining the results from phase I on your own. Although individual treatment plans vary, you can expect to stick with phase II for many years or even for the rest of your life. The second phase includes getting fitted for and wearing compression sleeves or garments, learning to put on and care for your garment correctly, and self-care. Your lymphedema specialist can help you keep lymphedema symptoms under control, ratcheting your plan up or down as needed. For example, some people need to wear a compression sleeve or garment around the clock, and others may have to wear a compression sleeve or garment for only a few hours a day. Some people find that lymphedema never becomes a major problem for them again, and others may experience flare-ups if the weather is too hot. And people who experience periods of worsening lymphedema may need to go through phase I again.
Every person is a little different. Over time, it gets easier to recognize how your body responds in certain situations so you can take action accordingly. However, it’s important to check with your lymphedema specialist before making any changes to your treatment plan.
Daily visits to a lymphedema specialist can be challenging to fit around a schedule and expensive when they are not fully covered by health insurance). If the phase I schedule is not working for you, let your lymphedema specialist know. There may be ways to modify your treatment plan safely. If you’re concerned about getting time off from work every day or about treatment costs, learn more about Workplace and Job Issues or Covering the Costs of Your Breast Cancer Care.
A pneumatic pump — also called an intermittent pneumatic compression pump — is a machine that has an inflatable sleeve or vest-like garment attached to it. The pump has multiple chambers that inflate like balloons one after the other to stimulate the flow of lymph in the right direction.
People who need a pneumatic pump to treat lymphedema in the arm sit upright in a chair next to the pump and insert their arm into the sleeve, which looks like an arm length blood pressure cuff. People who need a pneumatic pump to treat lymphedema in the chest or trunk can either sit up or lie down, depending on whether the pump has an inflatable sleeve or a vest-like garment. Pumping sessions can last up to an hour.
Pneumatic pumps were considered a mainstay of treatment before CDT came into wide use. But lymphedema specialists still consider pumps effective for some people when used in addition to other therapies. Depending on your situation, your lymphedema specialist may recommend a pump during either phase I or phase II of CDT.
Pneumatic pumps can cost from $800 to $5,000. Even if health insurance covers the cost of a pump, you may have to contribute some portion of the cost. If your lymphedema specialist recommends you use a pump at home as part of your treatment plan, it may make sense to rent one first so you can try it out. Once you and your specialist determine that the pump helps significantly, you may want to consider a longer-term rental or even purchasing one, if it’s possible. You need a prescription for the pump from your lymphedema therapist whether you’re renting or buying.
It’s important to know that using a pump on your own without talking with your lymphedema specialist is never a good idea. Your specialist can:
show you how to use the pump correctly
tailor the settings, pressure, and pumping action to your needs
tell you how frequently to use the pump and for how long
remind you that more pressure does not necessarily mean better results and that, in fact, lighter pressures are usually best
It’s best to follow your specialist’s recommendations. If you need to make any changes, ask your lymphedema specialist first.
Some people who use a pump for lymphedema of the arm sometimes notice hardening of the tissue (fibrosis) at the very top of the arm. If you notice anything unusual, let your lymphedema specialist know so you can make adjustments to your treatment regimen.
Kinesio tape is very flexible. When placed on the skin, Kinesio tape supports and stabilizes certain muscles and joints without restricting the body’s range of motion. The goal is to help the body heal from an injury naturally. Kinesio tape is very popular among athletes who play all sorts of different sports.
Some lymphedema specialists use Kinesio tape as part of the treatment plan for lymphedema The theory is that the tape can mimic the effect of MLD stimulating the movement of lymph by stretching the skin wherever it is placed. More research is needed to confirm whether the tape can help symptoms of lymphedema. But it’s good to know that using Kinesio tape is not likely to worsen the lymphedema.
If Kinesio tape is added to your treatment plan, it makes sense to ask your lymphedema specialist about previous experience and level of training. It’s also best to ask your specialist to show you how to use the tape correctly before using it on your own. Additionally, make sure you don’t put tape over skin that is irritated because the skin can tear.
Also known as water pills, diuretics help eliminate water and salt from the body by increasing the production of urine. Doctors often prescribe diuretics to treat conditions such as high blood pressure and congestive heart failure.
Some lymphedema specialists may prescribe diuretics during the first phase of CDT to help bring down overall swelling in some patients. But it’s important to understand that diuretics don’t have an effect on excess lymph. Because diuretics can cause a fluid and electrolyte imbalance, long-term use is best avoided.
If you have severe lymphedema, your lymphedema specialist may recommend laser treatments or surgery as part of your treatment plan to help improve symptoms.
Low-level laser therapy removes lymph nodes to help improve the range of motion in the affected area and reduce swelling and tightness. With laser therapy, your lymphedema specialist places a small, hand-held device directly onto your skin for short intervals. Infrared lasers penetrate the affected tissue and change the cells that are causing inflammation. The device looks a lot like the otoscope doctors use to look inside the ears during regular checkups. You don’t feel anything as the laser treatment is delivered. Even if you receive this treatment in the hospital, you can go home the same day.
It’s important to know that low-level laser devices are available for purchase — but it’s not a good idea to try to use these devices on your own. You may end up worsening lymphedema symptoms. It is far safer to see a specialist for more involved treatments, such as low-level laser therapy.
The body has a tendency to deposit fat in areas of the arm that are affected by lymphedema. Dr. Hakan Brorson, a surgeon from Sweden, was the first to discover that severe, non-pitting lymphedema — swelling that doesn’t indent when you push on it with your finger — contains a great deal of fatty tissue. He used liposuction to remove the fatty tissue and reduce the volume of the arm significantly. Similar to diuretics, liposuction doesn’t have a direct effect on lymphedema. But it can get the arm down to manageable size so you can continue treating the lymphedema with the treatments your specialist has prescribed to you. It’s important to know that plastic surgeons who perform liposuction aren’t necessarily qualified to perform liposuction for lymphedema of the arm.
Also called lymph node transplant, a lymph node transfer procedure connects transplanted lymph nodes with lymph vessels in the chest and arm. This connection allows the nodes to begin working effectively again and to reduce accumulated lymph in the arm. A reconstructive microsurgeon takes healthy nonessential lymph nodes from the abdomen or groin and transplants to the armpit. This procedure takes three hours and usually requires a one- to two-day hospital stay. It’s important to follow your doctor’s post-surgical instructions. Your lymphedema specialist can monitor to ensure that the area of the body from which the lymph nodes were harvested doesn’t show signs of lymphedema.
Also called lymphatico venous bypass surgery, lymphovenous anastomoses is a microsurgical technique that connects blocked lymphatic vessels to the veins in the affected area. This connection helps to drain excess lymph. The procedure is performed with general anesthesia, takes about two hours and usually does not require staying overnight in the hospital.
It’s important to remember that you may not necessarily be a candidate for any of these surgical procedures. These treatments are for people who have been diagnosed with severe lymphedema that does not respond to less-invasive treatments. If your lymphedema specialist recommends laser treatment or surgery, it makes sense to ask for advice on how to find a qualified surgeon — especially for the more specialized microsurgical procedures. And if you do have laser treatment or surgery, it’s important to follow the treatment plan you create with your lymphedema specialist so you can keep symptoms under control.
— Last updated on March 10, 2022, 8:41 PM