Lymphoedema after breast cancer treatment

The lymphatic system

The lymphatic system carries clear watery fluid called lymph. Lymph drains out from the small blood vessels (capillaries) into the body tissues.

Here is a short video to show you how the lymphatic system works:

Cancer or cancer treatment can affect the fluid drainage channels of the lymphatic system. Fluid then doesn't drain in the normal way, so the area swells. This swelling is called lymphoedema.

About breast cancer and lymphoedema

Some people will have lymphoedema after breast cancer treatment that includes:

• surgery to remove lymph nodes

• radiotherapy to the lymph nodes

Lymphoedema mostly affects the arms. But it can develop in other body areas such as the:

• breast

• armpit

• chest

• back

• shoulder

If lymphoedema is not treated, it may get worse. It can be painful and make it difficult to move your arm.

Find out more about what lymphoedema is and how it is diagnosed

Lowering your risk of lymphoedema

Sentinel lymph node biopsy

Your surgeon might use a procedure called a sentinel lymph node biopsy (SLNB). This is when the surgeon removes the first lymph nodes in the armpit.

Removing the sentinel nodes can damage the lymph system and can still cause lymphoedema. But the risk is lower compared to removing most of the lymph nodes in the area.

Find out more about surgery to remove lymph nodes

Infection

Infection in a cut or graze can increase fluid collection in your arm. This increases your risk of lymphoedema. There are things you can do to help protect your skin including:

• wearing gloves when gardening or doing housework

• using nail clippers rather than scissors

• using an electric razor or hair removal cream if you shave under your arms

• take care when playing with pets

• using insect repellent and mosquito nets to prevent bites

If you get a cut or graze, wash it well and cover it up with a plaster or dressing until it's healed.

Go to your GP straight away if it looks red or swollen. You might need antibiotics.

Find out more about infection and lymphoedema

Heat and sunburn

Severe heat and sunburn can increase your risk of lymphoedema. There are things you can do to reduce your risk of sunburn or severe heat.

• Spend time in the shade, especially between 11am and 3pm in the UK.

• Wear suitable clothing to protect your skin from the sun such as long sleeved tops, trousers, long skirts and wide brimmed hats.

• Wear a sunscreen with at least SPF 30 and 4 or 5 stars. Use it generously, reapply regularly and use together with shade and clothing.

• Avoid very hot baths and showers, including saunas.

Take care of your skin by using a non scented moisturiser every day to keep your skin moist.

Looking after your arm

You'll get instructions on what exercises to do after surgery from your healthcare team. They’ll tell you what you can and can’t do after your type of surgery. You’ll have a programme that will gradually build up your arm movement and strength.

Putting too much strain on your arm after surgery can increase your risk of lymphoedema. Don't use your arm for anything heavy until your team say you can. Let your team know straight away if you develop any swelling. 

If possible, try to avoid injections, blood tests or having your blood pressure checked on the side you had surgery. There is no firm evidence to suggest that having these procedures in the affected area will lead to lymphoedema. But if it can be avoided, it is probably better to do this.

Read more about lowering your risk of lymphoedema

Treating lymphoedema

You should contact your healthcare team as soon as you can if you notice any swelling in your arm. Early signs and symptoms you might notice include your watch strap, rings or clothes feeling tighter. Your arm, hand or shoulder may ache or feel heavy, stiff, tight or have a feeling of fullness.

You can't cure lymphoedema, but treatment aims to reduce swelling and stop the fluid from building up again. The treatment can take a little while to show results.

Treatments for lymphoedema include:

• an elastic sleeve to wear to reduce arm swelling

• an elasticated vest to reduce breast swelling

• your arm bandaged up with a particular type of short-stretch bandage that your lymphoedema specialist puts on

• exercises that help the fluid to drain from your arm

• a specialised massage called manual lymphatic drainage (MLD)

You might see a lymphoedema nurse specialist for these treatments. They will measure your arm and talk to you about your symptoms.

Your nurse, physiotherapist or lymphoedema specialist can teach you how to do gentle exercises at home to help prevent or decrease swelling in your arm. You'll get the most benefit from the exercises by wearing your sleeve when you are doing them.

Heavy lifting or too much repetitive exercise could make lymphoedema worse. So be sure to stop exercising if your skin is starting to become red, hot and sweaty. 

Find a lymphoedema practitioner

It can be more difficult to control the swelling if you're overweight. Talk to the dietitian at the hospital or your GP if you would like some help with healthy eating tips or losing weight. 

Find out more about treating lymphoedema

Positioning your arm

When you’re sitting down, it helps to position yourself in a way that helps the lymph to drain.

You can help stop further swelling in your arm by positioning it carefully. Raise your arm to a comfortable level by putting it on a cushion or a pillow, but not above the height of your shoulder.

Find out what other things you can do to help

Exercises for arm lymphoedema

Your lymphoedema specialist will show you arm exercises you can do to help your lymphoedema. They can also be useful if you are at risk of developing it.

The videos below show you how to do some exercises. Speak to your doctor or lymphoedema specialist if you are unsure about doing any of them and you should do them pain free.  These videos were made with the lymphoedema team at University College Hospital London. 

The first video shows deep breathing exercises. It is 1 minute long.

The next video is about arm exercises and is just over 4 minutes long. 

Your feelings

You may feel very angry, upset or embarrassed by the swelling in your arm. After going through treatment for breast cancer, it may feel too much to cope with lymphoedema as well.

If your arm is very swollen, it can affect your self esteem. You might feel less attractive and find it harder to go out and socialise.

If you are feeling upset about what has happened, do let someone know. Talk to someone you trust or speak to your lymphoedema specialist nurse.

Read more about coping with lymphoedema

More information

The Lymphoedema Support Network (LSN) has more information about exercises for arm lymphoedema.

Go to the Lymphoedema Support Network website

The British Lymphology Society (BLS) has a campaign called EveryBodyCan. It has information about lymphodema and activities you can do to keep your lymphatic system healthy.

Visit EveryBodyCan