Breast Cancer-Related Lymphedema: Risk Factors, Prevention, and Management.

If you are undergoing breast cancer treatment, you may need surgery or radiation, which can affect nearby lymph nodes in the armpit. Lymph nodes are responsible for draining lymphatic fluid from the body. When lymph nodes are removed or injured, lymphatic fluid may buildup and cause persistent swelling in the arm, called secondary lymphedema.

Lymphedema can develop immediately or decades after breast cancer surgery or radiation therapy. In our experience, nearly 20 percent of women who undergo treatment for breast cancer develop lymphedema. Knowing your risk factors can help you take steps to manage your chances of developing lymphedema, from physical therapy to a new, state-of-the-art surgery that may prevent it altogether.

Factors that increase the risk of lymphedema.

There is no definitive way to know during treatment who will develop lymphedema. However, there are some risk factors that can increase a woman's chances of getting lymphedema after breast cancer treatment. Risk factors for lymphedema may include:

• Having a large number of lymph nodes removed
• Exposure to radiation therapy, which can cause scarring and blockages
• Being overweight
• Smoking

Not all risk factors are avoidable. Even women who have early-stage breast cancer may be at risk, as your surgeon may need to remove one to three nodes with a sentinel lymph node biopsy during your operation. And, women with invasive breast cancer may benefit from an axillary lymph node dissection, which involves removing 10 to 40 nodes.

We're one of few health systems on the East coast to offer preventative surgery for lymphedema.

While you can't modify every risk factor, there are some things that can help to lower your risk. If you use tobacco, smoking cessation can reduce your risk. Likewise, achieving and maintaining a healthy body mass index (BMI) can decrease the odds you'll develop the condition. Physical therapy and rehabilitation after breast cancer treatment is also important for learning the best way to use manual lymphatic massage and compression to improve lymphatic drainage.

Until recently, physicians could only help manage the symptoms of lymphedema. Now, we have an exciting surgery that is effectively lowering the incidence of lymphedema among our patients. Lymphatic reconstruction is an advanced, microsurgical procedure that involves connecting the lymphatic vessels to the venous system to enable adequate drainage. The minimally invasive treatment can be performed at the same time as your lumpectomy, mastectomy, or breast reconstruction. Because it requires specialized skill and instruments, we're one of only a few health systems on the East coast to offer this preventative procedure.

Diagnosing lymphedema.

We can often diagnose lymphedema based on your medical history and a physical exam. For example, the circumference of your arm may indicate a diagnosis, especially if we know you have a history of lymph node surgery.

A common way to diagnose lymphedema is called bioimpedance, which is a way to measure electrical flow through body tissue. Once it is confirmed that the lymphatic channel—which contains clear, thin lymphatic fluid—is blocked, a team of doctors will determine the best treatment. In the meantime, they will try to reduce the swelling, often by wrapping the arm with a sleeve to provide some relief. Some patients get relief by having the affected area massaged and the excess fluid drained. But most patients end up needing surgical treatment for long-term relief.

To find out your best treatment options, you should meet with a multidisciplinary team that includes oncologists, reconstructive surgeons, physical therapists, and other medical professionals who will help with diagnosis and immediate action.

Surgical treatment options for lymphedema.

If you have mild or moderate lymphedema, you may benefit from surgery to either reconstruct the physical route of the lymphatic system. At MedStar Health, we can do this using two different sophisticated procedures, depending on your unique case. These include:

• Lymph node transfer: Lymph nodes are located in multiple places throughout your body. Therefore, our doctors can take lymph nodes from anywhere, such as the neck, groin or back, and transplant them wherever they’re needed using a microsurgical technique. It’s akin to bringing in a pump and activating it by making sure blood can flow in and out to avoid swelling.
• Lymphaticovenular bypass: Also known as LV bypass., this procedure is referred to as super-microsurgery, as it involves connecting the lymphatic channel right into a vein to ensure proper flow.

If lymphedema is more severe, liposuction may need to be performed on this area. This surgery uses a cannula to suck out the extra swollen tissue and fat that’s behind lymphedema. All three of these options work best in a team environment where they are being managed before and after surgery.

Recovery after lymphedema treatment.

Whatever path you choose, most patients can look forward to a quick recovery. All are minimally invasive treatment options that take about three to four hours to complete. They typically involve small incisions, followed by a wrap to protect and compress the area that was treated. Most patients can usually return home the next day. The patient returns to the doctor a week later to have the sutures removed.

You can expect to see results immediately, as the swelling will greatly reduce at first. Since lymph nodes are typically still dormant at the time of diagnosis and treatment, the arm may swell in the future. However, as they start functioning properly again, the swelling will recede once more.

Thanks to these advances, lymphedema doesn't need to be a lifelong concern for breast cancer survivors. If you're preparing for breast cancer treatment or you're recovering after-the-fact, talk to your doctor about your options for lowering or managing your risk of lymphedema.