Key points
- Lymphoedema is a side effect of breast cancer surgery and treatment
- It is a chronic condition that can be managed by the patient or lymphoedema therapist
- Cording is not associated with lymphoedema and requires separate intervention.
Lymphoedema
Lymphoedema develops when lymph fluid accumulates in the tissues. Treatment-induced lymphoedema can occur after the lymphatic drainage system is damaged, due to surgery (especially surgery to the axilla) or radiation therapy.
Lymphodema results in swelling of the affected limb (e.g. the arm on the side surgery has taken place). This can be permanent unless managed and it can lead to skin infections and cellulitis.
Symptoms of lymphoedema
The onset of lymphoedema can occur shortly after treatment or years later. It usually develops gradually.
Symptoms include:
- Swelling of the arm, hand, breast or trunk
- Infection
- The arm or limb might feel heavy, achy or stiff. There may be limited range of movement and jewellery or clothing may feel tighter than usual
- Swelling may be aggravated by heat, overuse or prolonged inactivity. Symptoms may be worse at the end of the day.
Further reading
Patient support
- Breast Cancer Foundation NZ webinar: Life with lymphoedema
- Patient information on Lymphoedema
- Lymphoedema NZ support groups
- Additional support available to people with lymphoedema
- Contact Breast Cancer Foundation NZ nursing team
Stages of lymphoedema
Stage 0 |
The lymphatic system has been damaged but swelling is not obvious |
Stage I |
Lymph fluid accumulates in the tissues, causing swelling that reduces with elevation. “Pitting” (indentation that remains after pressure is applied to a small area) may be evident. |
Stage II |
Swelling doesn’t reduce with elevation, pitting is obvious. |
Stage III |
The affected area is usually very swollen and swelling is irreversible. The tissue is hard and no longer pits. The overlying skin thickens, and gradually becomes discoloured. Increased fat deposits develop. |
Managing lymphoedema
Lymphoedema is a progressive, chronic condition. Early intervention can prevent infection, improve range of motion and improve patients’ quality of life. Evidence suggests that early intervention for those at risk of lymphoedema or those who have early lymphoedema leads to better outcomes.
Risk factors for lymphoedema
- The extent of surgery, lymph node removal and radiation therapy
- Skin infections on or near the affected area
- Injury (e.g. sprains, fractures, cuts or wounds) on the affected side
- Obesity and immobility
- Constriction from tight clothes, jewellery or blood pressure tests
- Exposure to excessive heat, including sunburn.
Patients may be advised to limit blood pressure readings, blood tests, injections or IV ports taken on the affected limb.
Treatment for lymphoedema
Lymphoedema therapy in New Zealand is based on the five ‘cornerstones’ of care:
- Light touch massage
- Compression bandages or garments
- Special care of the affected limb or area
- Exercise
- Medical taping.
