Lymphedema After Breast Cancer Treatment

It can happen when some or all the axillary (underarm) lymph nodes are removed during breast cancer treatment. It can also happen after the axillary lymph nodes had radiation.

The lymphatic fluid that’s normally filtered from the tissue collects and causes swelling.

Lymphedema often is in the underarm, armpit, or hand. It’s sometimes in the breast or chest wall, or legs. Lymphedema happens when some or all the axillary (underarm) lymph nodes are removed during breast cancer treatment. It also can happen after the axillary lymph nodes had radiation. 

It can be very helpful to have lymphedema therapy after breast cancer surgery or radiation therapy. There’s no cure for lymphedema. But the methods we describe in this guide may help ease symptoms.  

Many people do not know the signs and symptoms of lymphedema.

There are ways to predict who may be at risk for getting lymphedema, so we can prevent it from happening. 

Black and Hispanic women who had an axillary lymph node dissection have the highest risk of developing lymphedema. MSK researchers found Black, Hispanic, and Asian women have more arm symptoms and worse quality of life after the procedure.

At MSK, you will see an advanced practice provider (APP). They’re either nurse practitioners (NPs) or a physician assistant (PA). An NP is a registered nurse who has advanced education and training. A PA has advanced education and training and works alone or with your doctor to care for you.

They will assess your health history and cancer treatments to find out your risk for lymphedema. They can make a screening plan for you and refer you for treatment. 

Signs of lymphedema include: 

• Swelling in your arm, hand, breast, or chest wall.
• Feeling of heaviness, aching, or tightness in your arm.
• Your arm gets tired easily.
• Pain in your arm.

At MSK, we use the latest imaging technology to diagnose and evaluate lymphedema. This helps us find who is at risk for getting lymphedema. We can learn who is already developing the disease. We also learn which is the best treatment approach. 

• Indocyanine green (ICG)-enhanced near-infrared fluorescence (NIRF). The procedure lets our surgeons and APPs get a clear picture of how well lymphatic vessels are carrying fluid. NIRF gives us a real-time image of the lymphatic vessels in the affected area.
• MRI lymphangiography helps us to see the lymphatic system. We can tell the amount of fluid and fat in the area. This helps us see how advanced the lymphedema is so we can plan your surgery.
• Lymphoscintigraphy uses small amounts of radioactive tracing materials. It helps us see your lymphatic system and look for lymphedema at its earliest stages. 

If you have lymphedema after breast cancer surgery or radiation therapy, MSK experts can recommend the best treatment. 

Lymphedema can start any time after breast cancer treatment. Most often, it starts within the first few years after surgery or radiation therapy. But it can also start months or even years later. 

We know a few things that sometimes can trigger lymphedema. They include an injury, infection, burn, or other trauma to the arm. 

Gaining weight after breast cancer treatment may be another trigger. Research shows weight gain can strain the lymphatic system. 

We’re not sure that certain activities can raise your chance of getting lymphedema after breast cancer treatment. But we have general guidelines that can help prevent the condition.  

These steps can lower your chances of getting an infection that can lead to lymphedema. In the affected area:  

• Avoid cuts or breaks in the skin. They can cause infection.
• Use a moisturizer daily to help protect the skin.
• Be careful when you manicure your nails. Do not cut the cuticles.
• Wear gloves when gardening, cleaning, or washing dishes.
• Use care when removing hair under your arm. Do not use a straight razor or hair removal cream. They can cause skin breaks.
• Use insect repellent to avoid stings.
• Avoid tight jewelry, clothing, or anything that can squeeze too tight.
• Avoid sunburn. Use sunscreen with an SPF of at least 30.
• Avoid using heating and hot packs. 

Research in 2023 focused on younger women with a small estrogen receptor positive, HER2-negative cancer. It showed there’s no need to do a sentinel lymph node biopsy. At MSK, we may not recommend removing any of those lymph nodes. We're completely removing the risk of lymphedema. 
 
At MSK, we're trying to do everything we can to lower the chances of getting lymphedema. One of the newer surgery procedures is called immediate lymphatic reconstruction. 

Our early results show it's promising. The lymphedema rate may fall because of immediate lymphatic reconstruction. It’s possible that people who have immediate lymphatic reconstruction have a lower chance of needing compression garments in the future. 

Lymphedema treatment can include lymphedema therapy with MSK’s physical and occupational therapists. 

If surgery is best for you, MSK has experts in lymphatic microsurgery. Our plastic surgeons work with very delicate instruments under a microscope to fix small lymphatic and blood vessels. 

Lymphedema therapy is also called complete decongestive therapy (CDT). It involves massage, compression (squeezing), and exercise. 

It also involves taking care of your skin, eating well, and other helpful recommendations you can do at home.

The first step to getting help is to make an appointment with an expert trained in lymphedema therapy. 

Are you looking for lymphedema therapy near you? MSK has a lymphedema therapy clinic in New York City, and at our locations in Bergen, Monmouth, Nassau, and Westchester. You can make an appointment with our team of rehabilitation experts in lymphedema therapy.  

Lymphedema related to cancer may be prevented or treated with surgery. We use a method called microsurgery. Your surgeon works with delicate instruments under a microscope to move or reconnect small lymphatic and blood vessels.

You may be having surgery to remove lymph nodes to treat cancer. If so, microsurgery can be done at the same time to lower your risk for lymphedema.

Microsurgery also can treat people who already have lymphedema, helping with symptoms.