The little-known locations of lymphedema: face, neck, breasts and genitals

Lymphedema is a chronic disease characterised by an accumulation of lymphatic fluid in a limb, causing it to swell. The alteration to the lymphatic system responsible for the condition is either congenital or genetic (primary lymphedema), or caused by the destruction or obstruction of lymphatic nodes (secondary lymphedema), for example following trauma (such as surgery), malignant disease (cancer) or its treatment, venous disease, infection, etc. 1.

Lymphedema of the lower limbs is more common than that of the upper limbs, which are the two most common locations for lymphedema. However, lymphedema can affect other areas. It can affect the chest, back, abdomen, buttocks, breasts or genitals alone or in combination with lymphedema of the limbs 2.

Head and neck lymphedema: symptoms and treatments

Head and neck lymphedema is a common and often disabling c onsequence of ENT cancer or its treatments (surgery or radiotherapy). Head and neck lymphedema can affect external anatomical regions (for example, the face and neck) and internal structures (for example, the oral cavity and pharynx). 3, 4

Symptoms of lymphedema of the head and neck include: 3, 4

  • Asymmetric appearance or deformity, visible swelling
  • Feeling of heaviness, tightness, heaviness and numbness
  • Difficulty speaking, swallowing or breathing if the swelling is severe, change in voice, sensation of having a foreign body in the throat.

This pathology can also have a considerable impact on quality of life due to functional constraints (speech, swallowing, neck mobility) and on psychological health, particularly due to disruption of self-image 3.

Several treatments are recommended to manage these symptoms: 2, 5

  • Manual lymphatic drainage (MLD), which helps by improving lymphatic circulation, is a key part of the treatment.
  • Use of bandages or compression garments designed specifically for the face. Latex foam accessories can be used to apply localized pressure. Compression should never be applied to the neck area.
  • Surgical management of eyelid lymphedema may be considered.

Genital lymphedema

Genital lymphedema can occur after treatment for cancer in the pelvic area: cervix, endometrium, ovary, prostate, bladder, rectum 6. In men, genital lymphedema can affect the scrotum, penis and foreskin, and in women, the vulva, with possible involvement of the pubis and even the abdomen 6.

Symptoms may include heaviness in the pelvic region, discomfort and/or friction when walking, visual discomfort, burying of the penis and skin lesions. 6

Genital lymphedema can be very disabling and extremely difficult to manage. Careful monitoring for signs of infection and skin care are essential. 5

Several treatments are recommended to manage these symptoms: 2, 5 :

  • Manual lymphatic drainage (MLD) is strongly recommended.
  • Compression: Bandages or compression garments (shorts)
    • For women: treatment generally involves tailor-made compression garments (shorts, briefs, pants) with anatomical pads to treat thickened and swollen areas.
    • For men: multi-layer lymphedema bandages can be used and self-bandaging can be taught. Compression garments can also be used (shorts, briefs, trousers).
  • Monitoring for signs of infection
  • Skincare
  • Surgical management of lymphedema may sometimes be necessary to reduce the extent of the lymphedema.

Breast lymphedema: causes and possible solutions

Breast lymphedema is often a consequence of surgical and radiotherapy treatments for breast cancer (breast and axillary lymph node surgery, radiotherapy). Prevention and early diagnosis are essential. 2

Solutions to mitigate its effects include 2 :

  • Manual lymph drainage: This technique helps to reduce swelling by stimulating lymph circulation.
  • Compression garments: Suitable compression bras are available made-to-measure or ready-to-wear (including sports bras). They are specially designed to exert controlled pressure, thus preventing the accumulation of lymph. Thickening of the skin tissue can be reduced with foam pads.

Each treatment plan must be tailored to individual needs, and regular medical monitoring is crucial to optimising results.

Sources

  1. Grada, A., & Phillips, T. (2017). Lymphedema: Pathophysiology and clinical manifestations.. Journal of the American Academy of Dermatology, 77 6, 1009-1020 .https://doi.org/10.1016/j.jaad.2017.03.022.
  2. Fletcher J, Borthwick Y,Elwell R et al (2024) Practical issues in applying compression garments and wraps for management of lymphoedema. Wounds UK
  3. American Head and Neck Society (2019, May 27). Lymphedema - American Head & ; Neck Society. American Head & Neck Society. https://www.ahns.info/survivorship_intro/topical_review-lymphedema/
  4. Chaput G, Ibrahim M. Cancer-related lymphedema. Can Fam Physician. 2023 Oct;69(10):e206-e210. doi: 10.46747/cfp.6910e206. PMID: 37833084; PMCID: PMC10575661.
  5. Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International consensus. London: MEP Ltd, 2006.
  6. S. Vignes, P. Trévidic, Genital Lymphoedema, Journal des Maladies Vasculaires, Volume 40, Issue 2, 2015, Pages 108-109, ISSN 0398-0499, https://doi.org/10.1016/j.jmv.2014.12.146.