From the Guidelines
Lymphedema should be treated with manual lymphatic drainage and, if tolerated, compressive bandaging, as recommended by the most recent and highest quality study 1. This approach is part of a comprehensive treatment plan that focuses on reducing swelling and preventing complications. The treatment of lymphedema involves a combination of therapies, including:
- Manual lymphatic drainage (gentle massage techniques) to promote lymph flow
- Compression therapy using bandages or garments (20-60 mmHg pressure) to reduce swelling
- Meticulous skin care to prevent infections
- Specific exercises to promote lymph flow For mild cases, compression garments worn daily and elevation of the affected limb can help manage symptoms. It is also important for patients to maintain a healthy weight, as obesity is a risk factor for lymphedema 1. Additionally, patients should avoid tight clothing or jewelry on affected areas, protect the limb from injury, and avoid extreme temperatures. Early intervention is crucial as lymphedema is progressive and can lead to complications like recurrent infections and decreased mobility if left untreated.
The condition occurs because damaged lymph vessels cannot adequately drain lymph fluid, causing it to accumulate in tissues and leading to swelling. The risk of lymphedema is higher in patients who have undergone breast surgery and/or radiation, and it can occur immediately after treatment or develop after many years 1. The degree of swelling associated with lymphedema varies widely, and it can cause symptoms ranging from mild discomfort to overt pain.
In terms of prevention, supervised, slowly progressive resistance training may be safe and effective for breast cancer survivors with regard to lymphedema development, and may reduce the likelihood of arm swelling among those at high risk 1. However, more studies are needed in the area of lymphedema prevention. The most effective treatment approach is a comprehensive one that includes manual lymphatic drainage, compressive bandaging, and other therapies, as recommended by the most recent and highest quality study 1.
From the Research
Lymphoedema Treatment Components
- The standard of care for lymphedema encompasses risk reduction, early detection, Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home 2
- Phase-I therapy includes manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC) 2
- Home management includes many of the same elements, with adaptations for home treatment, and the use of an advanced programmable IPC device may support successful home management 2
Complex Decongestive Lymphatic Therapy
- Complex decongestive lymphatic therapy (CDT) has been the method of choice in conservative management of lymphedema, and it can achieve a 45-70% reduction in lymphedema volume 3
- CDT is a combination of four methods: manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, and skin care 3
- CDT is the most effective treatment as it reduces the symptoms of lymphedema and improves patients' functionality, mobility, and quality of life 3
Other Therapeutic Approaches
- Other conservative treatments have been proposed, such as Taping, Extracorporeal Shock Wave Therapy, Acupuncture, Photobiomodulation Therapy, Endermologie, Intermittent Pneumatic Compression, and Low-frequency, Low-intensity Electrotherapy 4
- The choice of the therapeutic approach to be employed should consider lymphedema characteristics, the therapist's experience, and the patient's wishes 4
- Collaborative lymphoedema management involves complete/complex decongestive therapy (CDT) using manual lymphatic drainage (MLD), compression therapy, skincare, and remedial exercises, adapted to the needs of the patient 5
Treatment Outcomes
- A decrease of limb volume, edema volume, and limb-related volume change during the intensive phase were observed in patients with postmastectomy arm lymphedema 6
- The health-related quality of life similarly showed improvement in both groups, with a high level of treatment satisfaction 6
- Treatment of lymphedema with CDT can achieve significant reductions in lymphedema volume and improve patients' quality of life 3