From the Guidelines
Lymphedema treatment should focus on reducing swelling and preventing complications through a comprehensive approach called Complete Decongestive Therapy (CDT), as recommended by the most recent and highest quality study 1. This approach includes manual lymphatic drainage (gentle massage techniques to move fluid from congested areas), compression therapy (using bandages, garments, or pneumatic compression devices), meticulous skin care to prevent infections, and targeted exercises to improve lymph flow.
Key Components of Lymphedema Treatment
- Manual lymphatic drainage
- Compression therapy
- Meticulous skin care
- Targeted exercises For daily management, patients should:
- Wear properly fitted compression garments (typically 20-30 mmHg or 30-40 mmHg pressure)
- Perform self-massage techniques
- Elevate affected limbs when possible Weight management is crucial as obesity worsens lymphedema, and patients who are overweight or obese should be advised to lose weight 1. While diuretics are generally not recommended for long-term use, antibiotics (such as cephalexin 500mg four times daily or amoxicillin-clavulanate 875/125mg twice daily for 7-14 days) should be promptly started for any signs of cellulitis. Advanced cases may benefit from surgical interventions like lymphovenous anastomosis or vascularized lymph node transfer. Lymphedema requires lifelong management because it results from damaged lymphatic vessels that cannot be fully restored, making consistent adherence to treatment essential for preventing progression and complications. Primary care clinicians should focus on the early identification and management of lymphedema among their patients with breast cancer, and 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
Treatment Options for Lymphedema
The treatment options for lymphedema can be categorized into several approaches, including:
- Physical therapy: This approach aims to reduce excessive capillary filtration and improve drainage of interstitial fluid and macromolecules from congested regions to normally draining lymph node sites 2.
- Drug therapy: This includes the use of diuretics or the coumarin/flavonoid group of drugs, with coumarin/flavonoids shown to reduce swelling in all types of lymphedema 2.
- Surgery: Indicated at an early stage for facial swelling, genital lymphedema, or when alternative therapy has failed 2, 3.
- Complex decongestive therapy (CDT): A multimodal therapy that consists of compression therapy, manual lymphatic drainage (MLD), exercise, and skin care 3, 4, 5.
- Pneumatic lymphatic drainage (PLD): A new device developed for the treatment of lymphedema, which has been shown to be effective and generally tolerable 5.
- Compression therapy: The most important treatment for lymphedema, which can be achieved through the use of bandages, stockings, or sleeves 3, 4.
- Manual lymph drainage (MLD): A technique used to improve lymphatic drainage, which can be used in conjunction with other treatments such as compression therapy and exercise 3, 4.
- Exercise: An important component of lymphedema management, which can help reduce swelling and improve lymphatic drainage 3, 4, 6.
- Skin care: Essential for preventing infectious complications and promoting overall skin health 3, 4, 6.
Phases of Lymphedema Management
The management of lymphedema can be divided into three phases:
- Attack or initial treatment phase: Aims to reduce the volume of lymphedema and is typically achieved through CDT 3.
- Maintenance phase: Aims to maintain the results achieved during the initial treatment phase and is typically achieved through the use of elastic compression and MLD 3.
- Withdrawal phase: The final phase of lymphedema management, which involves the gradual reduction of treatment intensity 3.