Lymphedema Risk Factors and Treatment Options for Breast Cancer Patients

If you are currently undergoing treatment for breast cancer, it’s important to know about possible complications that may occur afterward. One such complication is lymphedema. Lymphedema is the persistent swelling of the arm that may occur after mastectomy and lymph node removal during breast cancer treatment, due to the buildup of excess lymphatic fluid.

But what are the risk factors of lymphedema? Moreover, what treatment options are available for those who receive this diagnosis?

Factors That Increase the Risk of Lymphedema

At MedStar Georgetown University Hospital, we have observed that approximately 20 percent of women who undergo breast cancer treatment will end up with lymphedema. While there is no way of knowing during treatment who would be diagnosed, there are some risk factors we’re aware of that may increase the chances of getting lymphedema after breast cancer treatment.

For example, women with a higher chance of lymphedema have had many of their lymph nodes removed. Another risk factor is exposure to radiation during treatment, since this can cause scarring and blockages. Women who smoke or are obese are also more likely of developing lymphedema after breast cancer treatment.

While not all risk factors are avoidable, some are. If a patient is looking for ways to reduce their risks, smoking cessation and weight loss are two options.

Diagnosis of Lymphedema

Some patients get relief by having the affected area massaged and the excess fluid drained. But most patients end up needing surgical treatment for more long-term relief.

To find out the best treatment options, you should meet with a multidisciplinary team that includes oncologists, physical therapists and other medical professionals who will help with diagnosis and immediate action.

A common way to diagnose lymphedema is called bioimpedance, which is a way to measure electrical flow through body tissue. Once it is confirmed that the lymphatic channel - which contains clear, thin lymphatic fluid - is blocked, a team of doctors will determine the best treatment. In the meantime, they will try to reduce the swelling, often by wrapping the arm with a sleeve to get some relief.

Treatment Options for Lymphedema

One surgical option for mild to moderate lymphedema is a lymph node transfer.  Lymph nodes are located in multiple places throughout your body; as a result, doctors can take lymph nodes from anywhere - such as the neck, groin or back - and transplant them wherever they’re needed using a microsurgical technique.

It’s akin to bringing in a pump and activating it by making sure blood can flow in and out to avoid swelling.

Another procedure that may be considered is lymphaticovenular bypass, also known as LV bypass. This is referred to as super-microsurgery, as it involves connecting the lymphatic channel right into a vein to ensure proper flow.

If lymphedema is more severe, liposuction may need to be performed on this area. This surgery uses a cannula to suck out the extra swollen tissue and fat that’s behind lymphedema. All three of these options work best in a team environment where they are being managed before and after surgery.

Recovery for Lymphedema Treatment

Whatever path is chosen, most patients can look forward to a quick recovery. Most treatment options take about three to four hours to complete, and you can usually return home the next day. They typically involve small incisions, followed by a wrap to protect and compress the area that was treated. The patient returns to the doctor a week later to have the sutures removed.

Expect to see results immediately, as the swelling will greatly reduce at first. Since lymph nodes are typically still dormant at the time of diagnosis and treatment, the arm may swell in the future, however, as they start functioning properly again, the swelling will recede once more.

Due to advancements in less invasive treatment options, lymphedema is no longer a lifelong concern for life after breast cancer treatment.