Lymphedema After Mastectomy: Pain Management Tips – Verywell Health

Certain lifestyle changes may help prevent lymph node swelling
As a public health professional with over 10 years of experience, Katie is passionate about informing decision-making that impacts the health and well-being of individuals and communities.
Oliver Eng, MD, is a double board-certified surgeon and surgical oncologist and an Assistant Professor of Surgery at the University of Chicago.
Lymph fluid, a component of the body’s immune system, helps fight illness by carrying cells and fluid to address infections. Lymph nodes throughout the body act as drains.
If they become clogged, damaged, or are removed as part of a surgery, like a mastectomy (breast removal surgery), fluid can build up and cause swelling, known as lymphedema.
Learn more about identifying lymphedema after amastectomy, prevention, treatment, and getting support for the condition.

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Both the location where pain and swelling occurs and the timing of symptom progression can vary.

Arm swelling typically occurs closest to the site where the lymph nodes were removed during a mastectomy. However, swelling in other areas, like the chest or midsection, is also possible. Other lymphedema-related symptoms may include:

Lymphedema can occur any time after mastectomy surgery in which the lymph nodes are damaged or removed. Some people experience lymphedema within days to weeks after the surgery, which usually goes away on its own.
However, it's more common for people to develop swelling over time, typically 18 to 24 months following surgery. In this case, lymphedema does not improve or go away, and treatment is needed.
Around 30% to 47% of people who undergo a mastectomy and an axillary lymph node dissection to remove lymph nodes experience lymphedema after surgery. This number could be even higher for those who also undergo radiation therapy.
There is no single test that indicates a positive diagnosis for lymphedema. Your healthcare provider will ask you about your medical history, recent surgeries, when you noticed the swelling, if you've experienced swelling before, or if you have any other health conditions.
They may also run imaging or blood tests. Your healthcare provider may want to rule out other potential causes of swelling, such as cancer recurrence or deep vein thrombosis (DVT).
Several other conditions and treatments can lead to lymphedema beyond mastectomy-related removal or damage of the lymph nodes. These include:

There are several recommended behaviors to help reduce the risk of lymphedema. These include:
Generally, getting medical checkups, taking care of your skin, and incorporating healthy lifestyle behaviors, such as eating a nutritious diet, getting enough quality rest, and gradually engaging in physical activity, are risk-reducing recommendations.
Newer surgical techniques during mastectomy procedures have also been introduced to help prevent lymphedema. These techniques aim to repair or redirect the flow of lymph fluid to reduce the likelihood of swelling.

Unfortunately, researchers have not yet established why some people develop lymphedema. It’s also unclear why certain factors, including removal of lymph nodes, radiation therapy, and high body mass index (BMI), may contribute to its development.
Further, the recommended prevention strategies are based on the clinical experience of lymphedema experts rather than on strong evidence of their effectiveness.

Early diagnosis of lymphedema can lead to quicker treatment, fewer symptoms, and better quality of life. However, no treatment, including surgery, can cure the condition.
Combined decongestive therapy (CDT) is typically how lymphedema is treated. It combines several techniques and is completed in two phases.
Phase one of CDT treatment involves intensive support from a trained professional, including a physical, occupational, or massage therapist. This phase includes the following techniques:
Phase two of CDT treatment is the maintenance phase, which involves performing self-manual lymphatic drainage, wearing compression garments, exercising at home, and properly caring for your skin. These practices can help reduce swelling and pain and improve your quality of life.
For some people, surgery may be necessary, though it does not cure the condition. Surgical procedures remove excess fat, tissue, or skin resulting from the swelling. It may also redirect the way the lymph fluid drains in the body.
Your healthcare provider may recommend that you work with a physical or occupational therapist to address your lymphedema. Request a referral to a certified lymphedema specialist. It's also wise to check with your health insurance to determine whether the specialist and therapy services are covered before making an appointment.
Lymphedema is a common condition resulting from damaged or removed lymph nodes during a mastectomy that creates fluid buildup. It occurs when lymph fluid can't drain properly, resulting in swelling, pain, and limited use of the arm, chest, or midsection. Your healthcare provider will ask about previous surgeries, swelling, or other health conditions to diagnose the condition.
Prevention strategies include avoiding breaks in the skin or constriction of the affected area, wearing compression garments, and avoiding extreme temperatures. However, it is still possible to develop lymphedema after breast cancer surgery.

Lymphedema is typically treated with combined decongestive therapy (CDT), which involves techniques to reduce swelling and pain. Some may require a surgical procedure, but neither surgery nor CDT will cure the condition.
If you are experiencing swelling after breast cancer surgery, speak with your healthcare provider. Treating lymphedema early can reduce your risk of future damage and infection and increase your quality of life and ability to manage the condition.
Lymphedema after breast cancer surgery is common. It often develops in the arm but can also affect your midsection or chest. Lymphedema affecting the arm after breast cancer surgery occurs in about 21.4% of cases. Swelling due to lymphedema in the midsection has an incidence of about 10% and around 14% in the chest.
Stage 0 is characterized by lowered lymph fluid drainage and no swelling. In stage 1, swelling may come and go. The skin in the affected area may pit (an indentation is left when pressed). Elevating the affected area may help. In stage 2, the affected area remains swollen, and the swelling does not go away with elevation. The lymph fluid that's not draining may result in scarring. In stage 3, the scarring can lead to tough skin prone to injury and infection and can impair the use of the affected area.

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By Katie Wilkinson, MPH, MCHES
Katie Wilkinson is a public health professional with more than 10 years of experience supporting the health and well-being of people in the university setting. Her health literacy efforts have spanned many mediums in her professional career: from brochures and handouts to blogs, social media, and web content.

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