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When and Where Lymphedema Can Occur

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Swelling is a normal side effect of breast cancer surgery and radiation therapy. Typically, it affects the area right around the treatment site and lasts for just a few weeks after treatment, getting better over time as the body heals. This is called “acute swelling.” If the swelling persists, and if a larger region starts to become involved — such as the entire arm, hand, underarm, chest, or upper body — these can be signs that lymphedema is developing.

Some women develop a post-surgical complication called seroma. A seroma is the buildup of clear bodily fluids in any of the areas affected by surgery, such as the chest and underarm. Some seromas resolve on their own, but others need to be drained using a needle.

There is no set time limit on how long it’s normal for acute swelling to last, but some physicians use 3 months as a guide. Nicole Stout, MPT, CLT-LANA, Senior Rehabilitative Services Practice Leader at Kaiser Permanente, Mid Atlantic Region, sets the time limit even shorter, at about 2 weeks. “I have seen some patients whose doctors have looked at their swelling and said, ‘Well, sometimes that can take as much as 6 months or even a year to go away.’ That’s just not true and should NEVER be the case with swelling. If it’s persistent for more than 2 weeks after treatment, that’s a sign of lymphatic overload. The body is telling us a story: It can’t handle the fluid load, and if that fluid load persists, even in small amount, it can ‘tip’ the body into lymphedema. Conservative treatments such as manual lymphatic drainage or a light-grade compression sleeve can help.”

Although it’s possible for acute swelling to turn into lymphedema, the condition more commonly appears later on, after any treatment-related swelling has gone away. Generally, lymphedema is most likely to happen within 1-5 years after treatment, although the risk never entirely goes away. It can appear in any area of the upper body on the same side as the breast cancer — areas that were accustomed to draining lymph through any of the vessels or nodes that were removed or damaged during treatment. These include:

  • hand
  • arm
  • underarm
  • breast
  • chest wall
  • the front or back of the body starting from the bottom of the ribcage up, also called the trunk

Lymphedema can affect one or more of these parts of the body. Arm and hand lymphedema tend to be the most common after breast cancer. Lymph from the arm and hand has the farthest to travel to get to the underarm lymph nodes — and it has to work harder against gravity to get there! The arm and hand also are more exposed to the stresses of the outside world, such as heat, strain, and cuts.

Most research on breast cancer-related lymphedema has dealt with arm and hand lymphedema; for that reason, it will also be our main focus throughout this section of Whenever possible, though, we’ll also bring in information and advice about lymphedema affecting other areas of the upper body.

A note about axillary web syndrome (cording): Lymphedema is different from axillary web syndrome, also known as cording, which affects many people within several days or weeks of lymph node surgery (although it can occur later). In this condition, taut cord-like scar tissue extends from the underarm (axilla) and along the inner arm to the wrist, causing discomfort, pain, and limited range of motion. It’s thought to result from damage to the underarm lymph and blood vessels during surgery. Warmth, massage, and stretching exercises can help. As with lymphedema, it’s important to consult a therapist who has expertise in treating cording.

Although lymphedema and axillary web syndrome are both linked to the removal of lymph nodes, they result from two different processes: lymphedema from the backup of fluid into soft tissue, and axillary web syndrome from the scarring (or inflammation) of lymph or blood vessels in the underarm area. The vessels become hardened, causing the cords to form. Some experts believe that cording may increase the risk of lymphedema developing later on, but that’s not proven and more research is needed.

You can learn more about axillary web syndrome in the Treatment Side Effects section.

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