There is a complication that breast surgery and the removal of lymph nodes can produce. It is important that you learn about it.

The body's lymphatic system consists of protein rich fluid that circulates in conjunction with the entire circulatory system. Lymphatic fluid is filtered by lymph nodes and travels through the large lymphatic channels and also through the microscopic lymphatic pathways just under your skin. It is a delicate balance.

When you have all or part of your lymph nodes removed, you run the risk of getting a condition known as Lymphedema. This happens when the body cannot filter the lymphatic fluid properly throughout your arm or chest area because of scarring and/or the absence of lymph nodes. As a result, swelling can occur in your arm and sometimes your chest and trunk area. This is not just a cosmetic issue. The swelling must be taken seriously because the trapped fluid is a prime host for bacterial infections that can lead to cellulitis and sepsis.

The best treatment for lymphedema is prevention. You can reduce your odds of getting it if you refrain from repetitive activities with your affected arm; not lift heavy objects or carry a heavy purse with that arm; keep it moisturized so the skin stays supple and less prone to breaking; avoiding scratches from animals or gardening; sunburn; wearing anything tight or restrictive; not permitting any medical professional from drawing blood from that arm or from taking your blood pressure from that arm.

You can do all these things and still get lymphedema. A single mosquito bite can cause it to occur. So, before you have anything happen, find a lymphedema clinic and get a consultation. Let them measure you and teach you how to prevent getting it. You should also always have a prescription for an antibiotic on hand in case you see swelling, redness, itching or experience pain. You must discuss all of this with your doctor.

The treatment for lymphedema is compression and lymphatic massage that trains the body to use its superficial lymphatic pathways to channel the fluid out of your affected area. There is a very high success rate with treatment if you get it early.

There are three stages to lymphedema:

The First Stage

The first stage is the ‘pitting’ stage which means when you press your thumb into the arm the indentation stays there for a while. This is good because it means you can still reverse it.

The Second Stage

The second stage is the ‘spongy’ stage. The skin won’t indent, instead it will bounce right back when you press it. This is when the permanent hardening can begin. This also means that fibrosis has begun. Fibrosis is scar tissue that has built up between the tiny blood vessels because they have been stretched so much by the swelling. This stage is not always reversible.

The Third Stage

Obviously, the third stage is the worst stage. It is also known as the ‘hard’ stage, meaning you can not make an indentation with a finger and the skin will no longer bounce back. In this stage your arm is very big and the swelling is permanent and irreversible. Your joints may hurt and you may even have mobility problems.

There are two wonderful website for more information about Lymphedema. Please visit :

Preventing Lymphedema

There are things that can be done in the very early stages of lymphedema that can prevent it from becoming a problem. The trick is to recognize the symptoms and act quickly. As always, early detection is your friend. Watching and listening to your body is vital to your long term well being.

Things that produce lymphatic fluid in your arm

Extreme heat (hot baths, doing the dishes)

Strenuous repetitive exercises (mopping, sweeping, raking, etc)

Sunbathing, sun exposure, sun burn

Extreme cold (ice packs)

Tip: Reducing the amount of lymphatic fluid being drawn to your arm is the best first line of defense.

Things to Avoid

Tight clothing around your wrist

Tight bras that leave an indentation

Carrying grocery bags, heavy purses, etc. with affected arm

Getting your blood pressure checked in that arm

Use Extra Caution & Simple things Can Mean A Lot

Infections can not only be made worse by lymphedema but they can also cause lymphedema. A simple mosquito bite can bring on a permanent change in your lymphedema status, from none—to full blown. Take extra precautions with the following:

Shaving under the affected arm with a regular razor


Working in the garden

No blood draws from that arm

Things like sewing that could injure the skin.

Bug bites

Animal scratches

Simple things can mean a lot-

Keep your arm elevated.

Keep it out of the sun or hot water.

Don’t do repetitive motions like mopping or scrubbing

Don’t ever get your blood pressure checked in that arm

Don’t ever get a blood draw in that arm

Don’t carry anything heavy in that arm

Don’t wear anything tight around it- get extra links put in your watchband

Avoid bug bites, but if you do get one clean it until every germ is dead and then watch and wait for any unusual swelling. If you get a bug bite that swells up take a pen and draw a circle around the perimeter. If it gets bigger and goes outside that circle get to the doctor.

Avoid scratches, wear gloves gardening, don’t let your cat scratch you. But if you do get scratched, clean the area thoroughly as above

If you use a keyboard put a pillow under your arm so your wrist is not bent while typing.

What is GOOD for Lymphedema?

Maintain Weight

Keeping your weight down is one of the best ways to fight lymphedema and/or control it. Being overweight adds more pressure to your vascular system thus it adds more pressure to your lymphatic system. Make sure you stick with a low-fat diet high in vegetables and fiber.

It is important that you follow these precautions and tips to prevent lymphedema. You don’t want any more changes in your life do you? Listen to your body—recognize the symptoms. And then act fast by getting treatment.


Exercise is also good for lymphedema. Even light weightbearing exercise can actually improve lymphedema by increasing your circulation and the elimination of excess fluid build up. But you must speak with your doctor about which exercises are right for YOU.

SWIMMING! Lymphedema’s Secret Weapon
Swimming laps is the best exercise to reduce and prevent lymphedema. The pressure of the water on your arm while gliding through the water creates a natural massage and the action of using your arms helps create lean muscle which works as a built in pneumatic pump pushing the lymphatic fluid up and out of your arm.

On a personal note:

I am very careful with my lympedema. Even with all precautions taken, I must have some how nicked my skin. The symptoms started out as an all over malaise. I then started to feel as if all the nerve endings of my skin were on fire. Then the fever hit. It was 102. You need to know that any fever over 101.5 needs to be reported to your doctor immediately.

Because I had limited lymphatic fluid filtering in my arm the "soup" of lymph bred the bacteria that was in it. I got worse and was finally send to the hospital for IV antibiotics and a serious case of celulitis. Recognize the warning signs early and do not let it get to that point because lymphedema is a serious and potentially life-threatening condition and should never be taken lightly. ~ Gina Maisano

The Cost of Lymphedema
Lymphedema affects over 50 percent of all breast cancer patients. It decreases their quality of life and also costs them a lot of money because insurance companies do not cover the expenses for the treatment of this very real and very painful condition...

Lymphedema Raises Cost of Breast Cancer Care

TUESDAY, March 17 (HealthDay News) -- In breast cancer survivors, lymphedema -- an uncomfortable swelling of the arm and wrist -- can be one of the most vexing side effects of treatment.

Now, a new study has found that women who develop lymphedema fare worse than women without the condition and have higher out-of-pocket medical costs after radiation and surgery.

Breast cancer survivors who develop lymphedema report a lower quality of life, higher levels of anxiety and depression, an increased likelihood of chronic pain and fatigue and greater difficulty functioning socially and sexually, according to a study in the March 16 online issue of the Journal of Clinical Oncology.

Lymphedema also boosted two-year, postoperative medical costs by $14,877 to $23,167, the study found. The additional cost came from office visits, treatments for infections and mental health services, including prescriptions for antidepressants.

One reason for higher out-of-pocket costs: Insurance companies don't always fully cover lymphedema treatments, which can include compression garments and specially trained therapists who provide massages and physical therapy to help the area drain, said Ya-Chen Tina Shih, an associate professor of health economics at the University of Texas M.D. Anderson Cancer Center, in Houston, and an author of the study.

Although federal regulations and about 21 states require private insurance to cover lymphedema treatments after mastectomies, the laws are not specific about what constitutes lymphedema treatment and insurance companies have wide latitude in determining benefit levels, Shih said.

"Right now, it's really up to insurance companies' interpretation for what is appropriate lymphedema treatment," Shih said.

Lymphedema is caused by a buildup of lymphatic fluid, usually as a result of damage to the lymphatic system from radiation or surgery. Melanoma and cancers of the head, neck and pelvic area can also leave people susceptible to the condition, said Dr. Brian Lawenda, clinical director of radiation oncology at the Naval Medical Center in San Diego and a lieutenant commander in the U.S. Navy.

To some breast cancer survivors, lymphedema, which can develop years after radiation and surgery, is as distressing as the initial breast cancer diagnosis, the study found.

Using medical claims information on 1,877 women, researchers found that 10 percent sought treatment for lymphedema. However, that was probably an underestimate of the true incidence, Shih said, because there is no standard definition for lymphedema, doctors may not list lymphedema as a reason for the office visit and not all women seek treatment.

Previous research has shown that up to 50 percent of breast cancer survivors develop lymphedema, with 32 percent having persistent swelling three years after surgery, according to the study.

"It's a terribly overlooked problem," said Robert Smith, director of cancer screening for the American Cancer Society. "Many of these women have significant out-of-pocket expenses, and prolonged and chronic health problems, as a result of it. It's not curable, and once women have lymphedema, unless it's properly managed and treated, it can become progressively worse."

While some have mild cases, for others, the swelling can lead to loss of motion in the affected arm, cysts, skin thickening and infections such as lymphangitis, a bacterial infection of the lymphatic vessels, or cellulitis, an inflammation and infection just below the surface of the skin.

About a third of people with lymphedema get infections, which occur because the fluid backup inhibits the immune system's response, Lawenda said.

The study found that women in the western United States were more likely to have filed lymphedema-related insurance claims than those in the Northeast. Women in all regions of the country probably suffer from the condition equally, Shih said, but more states in the West have passed laws requiring insurance companies to cover treatments.

Standard treatments include keeping the skin clean and moisturized, being careful when clipping nails, wearing compression sleeves to prevent swelling, doing therapeutic exercises and having massage to promote manual lymphatic drainage, Lawenda said.

"It is a condition that's not curable," he said. "However, it is manageable, treatable and will improve."

SOURCES: Ya-Chen Tina Shih, Ph.D., associate professor, health economics, University of Texas M.D. Anderson Cancer Center, Houston; Robert Smith, Ph.D., director, cancer screening, American Cancer Society, Atlanta; Brian Lawenda, M.D., clinical director, radiation oncology, Naval Medical Center, San Diego; March 16, 2009, Journal of Clinical Oncology, online

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