From the Guidelines
Lymphedema in the right arm following mastectomy should be managed with complete decongestive therapy (CDT), which includes manual lymphatic drainage, compression bandaging or garments, exercise, and meticulous skin care, as this approach has been shown to reduce morbidity and improve quality of life 1.
Key Components of Management
- Manual lymphatic drainage to promote lymph flow
- Compression bandaging or garments to reduce swelling
- Exercise, such as finger flexion, shoulder rotations, and arm pumping, to mobilize lymph fluid
- Meticulous skin care to prevent infection
Preventive Measures
- Elevation of the affected arm when possible
- Avoiding blood pressure measurements, injections, or blood draws on the affected arm
- Weight management, as obesity can worsen lymphedema
Additional Considerations
- Pneumatic compression devices may be prescribed for home use in severe cases
- Medications, such as diuretics, may be used for short periods under medical supervision, but are not typically the primary treatment
- Early intervention is essential, as lymphedema is progressive and can lead to fibrosis, increased risk of infection, and decreased quality of life if left untreated 1
Importance of Early Detection and Referral
- Patients who develop clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about the diagnosis and treatment of lymphedema 1
From the Research
Lymphedema Treatment Options
- Complex decongestive therapy (CDT) is a commonly used method for treating lymphedema, which includes manual lymph drainage (MLD), compression bandaging, exercise, skincare, and patient education 2, 3, 4, 5, 6
- Studies have shown that CDT can be effective in reducing limb volume and improving health-related quality of life in patients with postmastectomy lymphedema 2, 6
Manual Lymphatic Drainage (MLD)
- MLD is a component of CDT that has been shown to be effective in reducing limb volume in patients with breast cancer-related lymphedema 3, 4, 5
- However, the contribution of MLD to decongestion has been questioned, and some studies have found that intermittent pneumatic compression (IPC) can be a suitable substitute for MLD in CDT 4, 5
Intermittent Pneumatic Compression (IPC)
- IPC has been shown to be effective in reducing limb volume and improving symptoms in patients with breast cancer-related lymphedema 4, 5, 6
- IPC can be used in combination with CDT or as a substitute for MLD, and has been found to be a suitable option for patients who prefer a more convenient and home-based treatment 4, 5
Comparison of Treatment Modalities
- Studies have compared the efficacy of different treatment modalities, including CDT alone, CDT with IPC, and IPC with self-lymphatic drainage, and found that all modalities can be effective in reducing limb volume and improving symptoms 4, 5, 6
- However, some studies have found that CDT alone may provide better results than combination modalities, particularly in the intensive phase of treatment 6