The lymph nodes in the armpit are the first point where any infection
of the hand gets controlled. Hence all the research into screening to detect early cancers, which can be treated with sentinel node biopsy, which prevents Lymphedema in most of the patients. If axillary clearance is done for breast cancer
, the chances of arm swelling
increases. We ask patients to avoid any trauma to that arm as in can incite cellulitis
and leave residual edema
in the arm. Also if any minor injury, we prescribe prophylactic antibiotics for the same.
Treatment of Lymphedema is according to the severity.
Obesity interferes with the treatment of Lymphedema. Hence if overweight, weight loss
is advised. Mild Lymphedema usually responds to limb elevation with compression stockings, exercises and skin care.
Moderate Lymphedema usually requires in addition to above, Manual lymphatic drainage, which is a massage like therapy performed by specially trained physiotherapists. Severe Lymphedema needs Complete Decongestive Therapy (CDT), which includes lymph drainage, multilayer compression bandaging
, elevation, remedial exercise, and skin care
. Those who donot respond may be offered Lymphapress, which is an intermittent pneumatic compression device. Whichever therapy is used, compliance is required which is the most difficult part.
Surgery is recommended only for the refractory edema. It may be in the form of 1) lymphatic bypass procedure (lymphoma
venous bypass or lymph node transfer
) for very select patients without fibrosis and venous hypertension
or 2) tissue reduction (Liposuction
or direct tissue excision)
Please ask your breast surgeon to refer you to a good physiotherapist
first and if need be to a plastic surgeon with experience in Lymphedema surgery