Treatment for Lymphedema After Mastectomy
Patients with clinical symptoms or swelling suggestive of lymphedema should be referred to a therapist knowledgeable about the diagnosis and treatment of lymphedema, such as a physical therapist, occupational therapist, or lymphedema specialist. 1
Understanding Post-Mastectomy Lymphedema
Lymphedema is a common complication following breast cancer treatment, affecting up to 40% of breast cancer survivors. It occurs due to blockage of the lymphatic system following surgery or radiation, leading to fluid retention and swelling in the arm, breast, or chest wall 1. This condition can:
- Develop immediately after treatment or years later
- Range from mild to severe swelling
- Cause symptoms from mild discomfort to significant pain
- Lead to functional limitations and disability
- Increase risk of cellulitis and infection
Treatment Algorithm
First-Line Treatment: Complete Decongestive Therapy (CDT)
Complete decongestive therapy is the standard of care for lymphedema management 1, 2. CDT consists of:
- Manual lymphatic drainage (MLD) - Specialized massage techniques to redirect lymph fluid
- Compression therapy - Multi-layered bandaging and/or compression garments
- Therapeutic exercises - To promote lymph drainage
- Skin and nail care - To prevent infection
- Patient education - For self-management
CDT is typically delivered in two phases:
- Intensive phase: Daily treatments by a trained therapist for several weeks
- Maintenance phase: Self-management with periodic professional reassessment
Research shows CDT can achieve 32-43% reduction in limb volume during the intensive phase 2, 3.
Alternative and Adjunctive Treatments
Manual lymphatic drainage vs. compression bandaging: These appear to be equivalent in effectiveness and can be considered as alternative options, with MLD preferred for patients with sensitivity to bandaging 1.
Intermittent pneumatic compression (IPC): Evidence suggests that adding IPC to CDT does not provide additional benefit and may be less effective than CDT alone 4, 5. One study showed CDT alone yielded higher mean volume reduction than combination therapy (43.1% vs. 37.5%) 5.
Elastic compression sleeves: Can be effective as maintenance therapy, with studies showing approximately 15% reduction in lymphedema with consistent use 6.
Prevention and Risk Reduction
Primary care clinicians should counsel patients on lymphedema prevention 1:
Weight management: Weight gain after mastectomy is a significant negative prognostic factor. Patients who maintain normal weight show better response to treatment (up to 25% greater reduction) 6.
Physical activity: Contrary to historical advice, supervised progressive resistance training appears safe and may actually reduce lymphedema risk in high-risk patients 1.
Special Considerations
Climate factors: Tropical or hot climates may limit consistent use of compression bandages 3.
Long-term management: Lymphedema requires ongoing management as there is no definitive cure 5.
Quality of life impact: Lymphedema significantly impacts quality of life and psychological well-being, requiring comprehensive care 1.
Follow-up and Monitoring
- Regular assessment of limb volume and symptoms
- Monitoring for signs of infection
- Evaluation of treatment adherence and effectiveness
- Adjustment of compression garments as needed
By implementing this comprehensive approach to lymphedema management, patients can experience significant improvement in symptoms, function, and quality of life.