Lymphedema after Breast Cancer Surgery

Lymphedema after Breast Cancer Surgery

Lymphedema, a type of swelling in the arm, is an unfortunate complication after breast cancer surgery. I hope this blog will give you a better understanding of the lymphatic system and how to recognize early signs of lymphedema if you’ve recently had or are about to have breast cancer surgery.
*Technically, lymphedema can occur in any limb after lymph nodes are removed, but to keep it simple, I’ll focus on upper extremity lymphedema today.

Overview of Lymphatic System

The lymphatic system is a network of nodes, vessels and organs that function as the body’s immune system. Lymphatic fluid (or lymph) is a protein-rich fluid which contains white blood cells. Lymph carries bacteria and viruses to be filtered through the lymph nodes and helps to prevent infection in the body.

Unlike blood, which is circulated around the body, lymph only flows one way (toward the heart) and requires a pressure gradient and muscular contractions to flow efficiently.

Anatomy of the Lymphatic System
Photo borrowed from Merck Manual1

Lymphatic Disruption after Breast Surgery

From my last post, you know that surgery for breast cancer usually involves removal of the tumor itself as well as removal of lymph nodes in the axilla (underarm). Lymph node removal is done because cancer cells can break off and travel through the lymphatic system and those nodes in the axilla are usually the first place they go.

To be sure the correct nodes are examined, the surgeon uses a radioactive dye to determine which nodes drain directly from the tumor site. Procedures to remove lymph nodes can range from removal of only a few nodes in a sentinel lymph node biopsy to many nodes (up to 20 nodes) in an axillary dissection.

With any amount of nodes removed (but especially with >5 nodes removed), there can be disruption to lymphatic flow through the axilla. In some cases, the lymph is unable to drain from the arm, resulting in lymphedema.

Lymphedema presents as a “swollen” arm, but this is not your usual swelling for two reasons. One, because lymphatic flow is a one-way street, the extra fluid needs to be physically cleared in some way (more on this in a minute…) and, two, because lymph is full of protein and fats that won’t drain into the venous system the way typical swelling does. The limb can actually grow and harden if left untreated.

Stages of Lymphedema – Photo borrowed from Sigvaris2

Studies show that lymphedema occurs in 0-3% of people who choose lumpectomy and up to 65-70% of those who have a modified radical mastectomy.3 Radiation therapy also seems to increase the risk of lymphedema. While many people will develop symptoms in the first 3 years after surgery, lymphedema can take up to 5 years to develop after cancer treatments. Be sure to ask your doctor or physical therapist what your risk for developing lymphedema is and learn about risk reduction practices.

Signs & Symptoms of Lymphedema

  • Swelling in the arm (usually only on side of surgery)
  • Heaviness/tightness of the arm
  • Reduced range of motion of the joints in the affected arm
  • Thickening/hardening of the skin

Physical Therapy Treatment for Lymphedema

A trained lymphedema physical therapist can be an incredible asset to someone who develops lymphedema. Ideally, a physical therapist will be able to work with a patient pre- and post-operatively to monitor girth measurements of the limb and identify lymphedema early on. Stage I lymphedema is potentially reversible, and both stage II and III can demonstrate significant reduction, so seeing a PT sooner than later is key in managing this condition!

With development of lymphedema, a physical therapist can perform or recommend the following interventions:

  • Bandaging of the limb or prescription of compression garments
  • Manual Lymphatic Drainage (specialized lymphatic massage)
  • Exercise prescription (progressive muscle pump, aerobic activity)
  • Patient education on proper skin care and prevention of infection

It’s important to see your doctor or physical therapist as soon as possible if you notice signs/symptoms of lymphedema. Here is a great resource to find a lymphedema specialist in your area. As always, feel free to reach out to me with any questions!

Aloha ❤

Big thanks to Joanne Zazzera, PT, DPT, WCS, for sharing her knowledge and editing this blog!

Lymphatic Drainage Techniques for Detox

Lymphatic Drainage Techniques for Detox

As you all know, chemotherapy involves a lot of heavy pharmacology. These medications are absolutely life-saving, but they can also take a toll on our body’s natural detoxification processes and can leave anyone feeling sluggish, tired, or generally unwell. This post is for anyone going through chemo, but also for anyone who lives on planet Earth right now. We are exposed to so many chemicals daily and we need to keep our bodies healthy!

Our body’s immune system includes the liver, spleen, thymus gland, bone marrow, and all of the lymphatic nodes and vessels.1 Its primary function is to DETOX our body and protect it against infection and disease. The lymph is the circulating component and thus a very important player in ridding our body of waste products.

An important thing to know about lymph is that it needs some help to flow. Unlike blood vessels, lymphatic vessels do not have smooth muscle that helps to pump it throughout the body, so lymph relies on things like muscle contractions, gravity, etc. to promote a 1-way flow through our bodies.

Read here or watch the video at the end of this post to learn about my favorite ways to perform lymphatic drainage at home:

Diaphragmatic Breathing

Diaphragmatic breathing, or belly breathing, helps to gently stimulate the cisterna chyli. The cisterna chyli is a large lymphatic collecting vessel in the abdomen where lymph from all 4 limbs begins to collect. Stimulating lymphatic flow here can help promote circulation of toxins OUT of the body. Since it’s close to the heart, I like to clear this region first so nothing gets “backed up” if the flow is a little sluggish through here.

Manual Lymphatic Drainage

Manual lymphatic drainage is a gentle, stroking type of massage that helps promote lymphatic flow. There are many ways to do this – with gentle massaging strokes as described in the video below or by using a dry brush or jade roller. The key is to keep the pressure light – lymphatic vessels run close to the surface of our skin so it doesn’t take much to get it going!

Bowel Massage

I finally get to talk about poop (a pelvic PT’s dream)! The liver relies heavily on regular bowel movements to clear out waste and toxins from our bodies. If you are constipated, your liver is working overtime. Typically, we should have a bowel movement every 1-3 days. Before resorting to laxatives or stool softeners if you’re backed up, be sure you are getting enough fiber in your diet and try bowel massage to get that stuff moving! Check out my recommendations for bowel massage in the video.

Acupressure / Acupuncture

During this last round of chemo, I found myself going back to a few key acupressure points that my acupuncturist recommended to assist with lymphatic drainage. I’ve been working two points primarily – one near my right elbow and one on my left shin. Also, check out the P6 point on the wrist, which helps significantly with nausea (even for pregnant women and those who get motion sickness).


Finally, my favorite way to get that lymph flowing – exercise! I recommend aerobic exercise, specifically, to increase circulation. It should be low intensity (you can still have a conversation while doing it) over a longer duration (20-30 minutes at a time), and you can pick your favorite activity like walking, biking, or swimming.

I hope this video helps you learn a a bit more about how to implement lymphatic drainage into your everyday life! Feel free to reach out to me with any questions you may have!