Post-mastectomy swelling, known as lymphedema, is a chronic condition that can develop after breast cancer treatment. This swelling occurs because the surgical removal or radiation of lymph nodes, typically in the armpit, disrupts the body’s natural drainage system. When vessels and nodes are damaged, lymph fluid builds up in the arm, hand, or chest area. Managing this fluid accumulation requires a proactive, multi-faceted approach, often guided by specialized therapists, to reduce swelling and prevent complications.
Manual and Therapeutic Approaches
A cornerstone of lymphedema management involves specialized, hands-on techniques designed to reroute the trapped fluid. Manual Lymphatic Drainage (MLD) is a gentle, skin-stretching massage that encourages lymph fluid to move from the swollen area toward functioning lymph nodes. This technique uses very light, rhythmic movements without oil to stimulate the lymphatic vessels and improve the reabsorption of fluid. The therapist often begins by “clearing” the lymph nodes in the neck or groin to create a space for the fluid from the swollen limb to drain into.
MLD should only be performed by a Certified Lymphedema Therapist (CLT), who has specialized training in these specific massage methods. A CLT can also teach Simple Lymphatic Drainage (SLD), a modified technique for self-care at home to maintain the effects of therapy. Treatment courses often need to be consistent to see a measurable reduction in arm volume.
Therapeutic management also includes meticulous skin care. The compromised lymphatic system makes the affected limb more susceptible to infection. Daily moisturizing helps to prevent dry, cracked skin, which can serve as an entry point for bacteria. Patients should also take precautions like wearing gloves for gardening or using insect repellent to protect the skin from cuts, scrapes, and bites.
Compression Strategies
External pressure is necessary to prevent the re-accumulation of fluid. Compression garments, such as sleeves and gloves, are elastic materials that apply constant, graded pressure to the limb, helping to move fluid out of the tissues and maintain the volume reduction achieved during therapy. These garments are custom-fitted or sized to provide a specific pressure level, measured in millimeters of mercury (mmHg), and must be worn consistently throughout the day.
Multi-layered short-stretch bandaging (MLBB) is often used during the intensive, initial reduction phase of treatment. This involves wrapping the limb with several layers of padding and bandages that have low elasticity, which provides a high working pressure when the muscles contract. Bandaging is often followed by a transition to custom-fitted compression garments for long-term maintenance.
Pneumatic compression devices (PCDs) are mechanical pumps that provide intermittent, sequential pressure to the limb via a sleeve or garment. The pump inflates and deflates sections of the sleeve in a timed cycle, moving the fluid from the limb toward the body’s core. These devices are typically prescribed for at-home use. A lymphedema specialist determines the most appropriate compression strategy based on the severity and stage of the swelling.
Incorporating Movement and Elevation
Fluid movement relies heavily on muscle activity and gravity. Elevation uses gravity to assist in lymphatic drainage, requiring the affected limb to be raised above the level of the heart whenever possible. This positioning helps counteract the pooling of lymph fluid that occurs when the arm is held down. Patients are encouraged to elevate their arm frequently throughout the day.
Movement and exercise utilize the muscle pump mechanism. When muscles contract, they squeeze the lymphatic vessels, propelling the lymph fluid forward. Low-impact, rhythmic exercises are recommended, as high-impact activity can sometimes cause inflammation. Gentle stretching and range-of-motion movements help to work the muscles without undue strain.
Deep breathing, which involves exaggerated diaphragm movement, can stimulate lymph flow. This rhythmic action creates a vacuum effect in the torso, pulling fluid from the extremities toward the center of the body. Any exercise regimen should be approved by a lymphedema therapist to ensure movements are appropriate and do not cause a sudden increase in swelling.
When to Seek Professional Guidance
Certain signs indicate the need for immediate medical attention. Cellulitis, a bacterial skin infection, can rapidly worsen lymphedema and cause systemic illness. Symptoms of cellulitis include a sudden increase in redness, warmth, and tenderness in the affected area, often accompanied by fever, chills, or a general feeling of being unwell. The skin may also appear shiny or stretched.
If signs of infection appear, contact a healthcare provider immediately, as cellulitis requires prompt treatment with antibiotics. Untreated cellulitis can lead to more severe complications, including sepsis, and can further damage the lymphatic system. Any sudden, significant increase in swelling, new or worsening pain, or a change in the limb’s appearance should be reported to a lymphedema specialist. The specialist can monitor the condition and adjust compression or therapeutic techniques.