Lymphedema can develop at any time following treatment for breast cancer and there is no definite way to prevent its onset. Once lymph nodes are removed, the patient will be at risk to develop the condition. The addition of radiation to a breast cancer treatment plan increases the risk for developing lymphedema. Therefore, patients should follow certain precautions to help minimize that risk.

Protect the skin

The rationale for this is twofold. First, any break in the skin, whether it be from a paper cut or a sterile needle, will cause the body to initiate an immune response. The body will rush lymphatic fluid to the area to prevent infection. However, because the body's lymphatic system has been altered by surgery and/or radiation, it may not be able to handle the sudden rush of lymphatic fluid to the area where the break in the skin occurred. Second, even if edema is not yet present, many arms have "sluggish" lymphatic drainage after treatment for breast cancer. A break in the skin opens the limb to bacteria that can grow rapidly in the protein-rich tissue. An infection of the skin, known as cellulitis, can occur and with it, edema.

Watch for signs of infection

These signs include redness, warmth, swelling, and pain. If some or all of these symptoms occur, the patient should contact a physician to see if a course of antibiotics is warranted. It is critical that an infection can occur without warning and without apparent cause. They should know that any sudden change in the status of the arm (i.e. increase in size, thickening of the tissue, etc.) should be reported to a health care provider.

Restore shoulder range of motion

Lymphatic fluid moves with movement. Normal shoulder function and the ability to use the arm normally for all activities will help with lymphatic flow. Chest wall tightness and axillary tightness may compromise normal lymphatic flow. Simple stretching exercises can be initiated at any time after surgery to help regain normal shoulder range of motion (see Recovery In Motion exercise booklet).

Gradual return to activity

Following breast cancer surgery, any activity or exercise can be resumed as long as the return is gradual. Activity with the limb causes an increase in lymphatic flow. Too much activity performed too quickly may cause an increase of lymphatic fluid in a limb that may not be able to hand it effectively, resulting in the formation of edema. Therefore, return to normal activities as tolerated, using the limb as a barometer of how well the body is handling the increased activity. Reconditioning the limb to accept the increase in lymph flow caused by activity may help minimize the risk of activity-related edema.

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Many patients experience some swelling following breast cancer surgery. Post-operative edema may be prolonged or worsened by the radiation therapy or chemotherapy. With this, much of the edema related to the cancer treatment itself will resolve. Any edema must be acknowledged at its onset. When the edema persists three months beyond when the cancer therapy ends, it should be treated.

When edema is moderate to severe (approximately a 1 inch increase at most measured points along the arm when compared to the uninvolved side), the signs are clinically apparent. The limb is obviously swollen and may or may not be painful. When the edema is mild or a new onset, the signs may be less noticeable. The patient may experience a "fullness" or "heaviness" of the limb, again with or without pain.

Finally, it is important to remember that swelling does not have to occur only in the arm. The torso is equally as vulnerable to developing lymphedema as it is the site of the surgery and radiation therapy. The tissue of the torso is also drained by the same lymph nodes which drain the arm and therefore is at risk for edema. When it occurs, edema of the torso and breast (as in the case of a lumpectomy) must be considered as relevant as limb edema, and the appropriate treatment should be used.

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