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Additional Surgery and Other Treatments After a Lymphedema Diagnosis

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What if you’ve been diagnosed with lymphedema and you need or want to have surgery on that same area in the future? Examples could include surgeries related to the breast cancer — such as breast reconstruction (if you did not have immediate reconstruction) or surgery to treat a recurrence — or unrelated procedures such as shoulder, arm, or hand surgery, or surgery anywhere in the chest region. Even if your surgery is going to happen on the opposite side of the body, it’s normal to be concerned that you could have problems with lymphedema there, too, given your history.

Make sure that your surgeon or other doctor treating you knows about your lymphedema history. Ask if anything can be done to avoid or minimize any further damage to your lymphatic system. Also, work with your lymphedema therapist in advance of your treatment to see what he or she recommends. If you haven’t been exercising the arm or upper body consistently, then getting back into exercise before your surgery may be helpful. Your therapist also may have recommendations for after the procedure, such as undergoing manual lymphatic drainage, bandaging the arm or other area, or wearing compression — all in an effort to keep excess lymph and fluid from building up in the area again. Consider seeing your therapist regularly in the months after your procedure so that any problems can be caught early.

We still don’t know for sure whether breast reconstruction can increase lymphedema risk or the risk of lymphedema flare-ups. Recent studies have not shown a connection between breast reconstruction and lymphedema risk. Some clinicians have found that their patients who undergo reconstruction are not at any greater risk of lymphedema than those who do not.

We also don’t know if reconstruction could make lymphedema worse in women who already have it. The concern is that surgery to the chest area can cause inflammation that brings more fluid to the area. Theoretically, this could increase the risk of flare-ups. However, there also have been some reports of patients with lymphedema who had delayed reconstruction — that is, reconstruction that happens later on, after treatment is complete — and experienced an improvement in their limb size. The numbers of patients reporting this are small right now. The theory is that the reconstruction may release scar tissue from the previous surgery, which then would allow fluid to flow more freely.

If you have lymphedema and are planning reconstruction, see your lymphedema therapist. He or she can follow you more closely as you go through the reconstruction process and adjust your treatment plan as needed.

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