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Reducing Lymphedema and Flare-Up Risk: Things to Do

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Follow these steps to protect the hand, arm, underarm, chest, and back on the same side you had your breast cancer surgery — or on both sides if you were treated for bilateral breast cancer (cancer in both breasts).

To protect your skin:

  • Moisturize daily to keep skin supple and prevent cracking. Try a gentle lotion such as Eucerin, Moisturel, or Aquaphor.
  • Keep your hand and arm clean, but don’t use harsh soaps or strong deodorant soaps. Use a gentle moisturizing soap such as Dove.
  • Wear protective gloves for activities that could stress the limb or injure the skin, and try to find gloves that extend up the arm. These include rubber gloves for cleaning or washing dishes; gardening gloves for planting, pruning, and outdoor chores; and oven mitts for cooking and grilling. You can even get chef’s gloves to use when cutting with sharp knives or using a grater.
  • Use a thimble when sewing.
  • Use insect repellents that won’t dry out the skin and don’t contain harsh chemical ingredients. Examples include Belle’s Botanicals Bug Be Gone Aromatherapy Lotion and/or Body Balm, and Badger Anti-Bug Balm, which is a USDA-certified organic insect repellent. Avoid brands that contain a significant amount of alcohol. Any ingredient that ends in “ol” is a type of alcohol.
  • Push your nail cuticles back after a shower and keep them moisturized.
  • Try a cream hair-remover (try one labeled for sensitive skin) instead of a traditional razor to remove hair from your underarms. Be sure to test any hair-removing creams on another area of the body first. If you prefer a razor, try an electric version, but still take care to avoid any skin irritation or nicks.
  • Apply antibiotic ointment — such as Bactroban, Neosporin, Polysporin, or the store-brand ointment with the same ingredients — to any insect bites, torn cuticles, or cuts you notice. Cover cuts with a band-aid and report any signs of infection to your doctor or lymphedema therapist.

To protect your arm and hand from overuse or trauma:

  • Be cautious about suddenly lifting something heavy — such as a grocery bag, gallon of milk, or a small child — until you get a sense for what your arm can handle. Try to carry heavy items on the other side of the body at first, until you’ve built up strength in your arm and upper body. (If you had breast cancer surgery on both sides, limit all heavy lifting at first.)

    You may be asking yourself, “How much is too much? And for how long?” It’s impossible to give a single answer that applies to everyone. It depends on the condition of your arm going into surgery and how it feels afterward. If you rarely use your arm and upper body for any strenuous activities, you may need to take it more slowly than someone who’s an active rower, weight lifter, or yoga instructor, for example. Your lymphedema therapist is in the best position to help you gauge what’s safe.
  • Be careful when you start tackling activities such as scrubbing, mopping, or raking — anything that involves repetitive use of the arm and upper body. Take frequent breaks and stop if your arm feels tired, heavy, or achy. Your lymphedema therapist can help you figure out when these activities are likely to be safe again. Ask about stretches you can do during breaks and after heavy activity to keep lymph flowing.
  • Protect your arm and upper body from sunburn with sunscreen. Use a product with an SPF of 30 or higher — the more protection the better.
  • Use warm water for baths, showers, and cleaning (not hot water).
  • Make sure any bras, camisoles, or tops you wear don’t fit too tightly around your arms or chest.
  • Work with a trained lymphedema therapist to figure out what types of gradual exercise suit your needs. See the Lymphedema and Exercise section for more information.
  • If you’ve decided to wear a breast prosthesis after mastectomy, go with the lightest prosthesis you can find, so as not to put too much pressure on the upper body.
  • Ask your doctor how other health conditions you may have, such as diabetes, high blood pressure, congestive heart failure, or other cardiovascular conditions, could affect your lymphedema. All of these conditions can affect the blood circulatory system, which in turn can impact the lymphatic system.

A note about compression sleeves: Experts don’t always agree on whether it ever makes sense for a woman who has not had any lymphedema symptoms to wear a compression sleeve (a stretchy garment worn on the arm to apply pressure that helps the flow of lymph up the limb). Some feel it’s not necessary. Others feel that, if you have many risk factors for lymphedema, it’s wise to wear a sleeve during physical activities involving the arm. Talk to your lymphedema therapist to see what he or she recommends.

Nicole Stout, MPT, CLT-LANA, Senior Rehabilitative Services Practice Leader at Kaiser Permanente, Mid Atlantic Region, explains: “Do we say that every woman who’s had lymph nodes removed needs to wear a sleeve? Absolutely not. But it’s worth considering each individual’s risk level. For instance, if I have a patient who had 30 lymph nodes removed and radiation to the chest wall and underarm, and she asks about wearing a sleeve for exercise or travel, my usual response would be ‘I’d rather that you have it than not have it.’ Or let’s say I have a patient with risk factors who is planning a bike trip through Europe. If the sleeve is light-grade and well-fit by an expert, there is no harm in having them wear it during activities that can put them at risk. We don’t know for sure yet if this will lower lymphedema risk, but theoretically it will help with fluid flow.”

And finally, live a healthy lifestyle. Common-sense steps such as eating healthy foods, quitting smoking, and limiting alcohol, in addition to getting regular exercise, can make your body healthier. Although not proven to reduce lymphedema risk, these steps can’t hurt and may help. If you need support, talk to your doctor or nurse, who can refer you to other specialists or programs.

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