Secondary or acquired lymphedema is an accumulation of protein-rich fluid that occurs when lymphatic vessels are impaired. It differs from other edemas in that it is not just water that causes the swelling. Lymphedema not only has a "fluid" component but a "solid" component as well. This unique feature of lymphedema occurs because the lymphatic system is responsible for draining the tissue of fluid and other materials such as protein. If lymphatic vessels are impaired, these materials may be left behind in the tissue. The result is swelling either in the hand or the entire arm and sometimes the shoulder, chest and back as well.
For the physiology of lymphedema, click here.

Despite its long history in the literature, lymphedema remains an enigma condition, often sudden and without warning, coupled with a woman's inability to stop the arm from swelling, causes a sense of helplessness and loss of control and often precipitates fear and self-blame. This can be worsened by frustration with the perceived apathy of the medical community and the difficulty women with lymphedema have in finding information on the condition and its treatment. Often it's not apathy but lack of knowledge among health care professionals that leaves lymphedema untreated.

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Lymphedema of the upper extremity can result from the axillary dissection that accompanied most breast cancer surgeries before the newer sentinel lymph node dissection was instituted. Axillary dissection is still part of treatment for breast cancer when malignant cells are discovered in the sentinel lymph node indicating a spread to the lymphatic system. The condition is exacerbated by the radiation therapy that follows many breast-conserving techniques. Radiation to the axilla in cases where the patient is node positive is also a causative factor.

The lymph system helps to maintain the body's fluid balance. The lymph fluid from the arm drains into the axilla ( armpit) and flows through the axillary lymph nodes. The lymph nodes act as filters to destroy toxins and viruses, for example, and therefore play an important role in the immune system. Once this system is compromised either through surgery and/or radiation, the arm is much more prone to infection through even a pin prick or a mosquito bite.

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