Lymphedema after breast cancer

Lymphedema of the arm, also known as ‘big arm’, affects 5 to 20% of women treated for breast cancer. This uncomfortable condition, with a risk of complications, requires compression therapy and drainage of lymph fluid.

During breast cancer treatment, the lymph nodes in the underarm region on the side of the affected breast often need to be removed (by axillary lymph node dissection or sentinel lymph node biopsy). In some cases, the lymph then has difficulty circulating properly and builds up, causing an increase in the volume of the arm on the side where breast surgery was performed.

Variable time onset and course

The risk factors for developing the condition primarily include radiation exposure during radiotherapy, being overweight, a poorly balanced diet and hormonal status in women. Often moderately extensive, it sometimes only affects the hand, sometimes the whole arm and even the armpit. The oedema may be mild or severe, hard or soft.

Treatment to feel better and prevent complications

Lymphedema causes feelings of heaviness and limitation of movements, adversely affecting mobility and quality of life. In addition, since the immune system is less effective, the skin on the arm is at higher risk of infection. This lymphedema should therefore be treated promptly, in two phases:

the first “intensive” phase, to reduce the volume of the arm, via lymphatic drainage and the application of bandages by a physiotherapist;
The second, known as “maintenance” phase, to maintain this reduction by wearing compression garments such as compression sleeves.

The treatment should be combined with a healthy lifestyle and, if necessary, specific exercises and skincare. Surgery like liposuction, or reconstructive lymphatic surgery like lymphovenous anastomosis (diverting of vessels to bypass the damaged area) and lymph nodes transfer can sometimes be proposed when these treatments have not been effective. This surgery can help reduce volume and discomfort.

What is the difference between lymphocele and lymphedema?

It is essential to differentiate between lymphedema and lymphocele, as these two conditions, although involving the lymphatic system, are distinct. Lymphedema is a chronic accumulation of lymph in the tissues, generally due to damage to the lymphatic system, leading to persistent swelling in the arm. A lymphocele, on the other hand, is characterized by a localized accumulation of lymph under the skin, forming a cyst in a specific area, usually in the region operated on. Lymphocele is therefore a frequent post-operative complication resulting from damage to the lymphatic vessels, which appears as a well-defined pocket of fluid, unlike the diffuse swelling of lymphedema.

Sources

Azuar AS, Uzan C, Mathelin C, Vignes S. Actualisation des indications et des techniques de prise en charge du lymphœdème après chirurgie du cancer du sein [Update of indications and techniques for the management of lymphedema after breast cancer surgery]. Gynecol Obstet Fertil Senol. 2024 Mar;52(3):142-148. French. doi: 10.1016/j.gofs.2023.12.008. Epub 2024 Jan 6. PMID: 38190967.
Inca website: Lymphoedema. DiSipio T et al, Incidence of unilateral arm lymphedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol, 2013 May; 14(6): 500-15 Hayes S.C., Rye S., Battistutta D., Newman B./ Prevalence of upper body symptoms following breast cancer and its relationship with upper body fuction and lymphedema. Lymphology, 2010, 43, 178-187.
Vignes, M. Coupé, F. Beaulieu, L. Vaillant, pour le groupe ‘ Recommandations ’ de la Société Française de Lymphologie - Les lymphœdèmes des membres : diagnostic, exploration, complications - Journal des Maladies Vasculaires (2009) 34, 314-322
Institut National Du Cancer. Lymphoedema after cancer treatment - Breast cancer. Fiche pdf. Institut National du Cancer.
Dépistage et prévention du cancer du sein. Haute Autorité de Santé, document PDF, février 2015. https://www.has-sante.fr/upload/docs/application/pdf/2015-04/refces_k_du_sein_vf.pdf