Breast cancer health centre

Lymphoedema after breast cancer surgery

What is lymphoedema?

Lymphoedema is a build-up of lymph fluid in parts of the body, which may follow breast cancer treatment.

Lymphoedema can be due to damage to the lymphatic system from surgery or radiotherapy treatment.

There are two types of lymphoedema: primary and secondary.

Primary lymphoedema is rare and is caused by the absence of, or abnormalities in, certain lymph vessels at birth.

Secondary lymphoedema occurs as a result of a blockage or interruption that alters the flow of lymph through the lymphatic system and can develop from an infection, malignancy, surgery, scar tissue formation, trauma, deep vein thrombosis ( blood clot in a vein), radiotherapy or other cancer treatment.

Who is at risk of developing lymphoedema?

People who have had any of the following procedures may be at risk of developing lymphoedema:

• Mastectomy in combination with axillary lymph node removal
• Lumpectomy in combination with axillary lymph node removal
• Combined cancer surgery and radiotherapy to a lymph node region (such as the neck, armpit, groin, pelvis or abdomen)
• Radiotherapy to a lymph node region

Lymphoedema can occur within a few days, months, or years after surgery. A small amount of swelling is normal for the first four to six weeks after surgery.

What happens after my breast surgery?

Lymphoedema develops after breast surgery because there is an alteration in the pathway that drains the fluids involved in the immune system. It can occur at any time after the surgery. If untreated, it can become worse.

Following surgery, a doctor will examine you and take arm measurements. Sometimes, there may be redness or pain in the arm, which may be a sign of inflammation. Depending on your symptoms, your doctor will then consider the best treatment options for you.

What are the signs and symptoms of lymphoedema?

If you suspect any of the symptoms listed below, seek medical advice straight away. Prompt treatment can help get the condition under control.

• Swelling in the arms, hands, fingers, shoulders, chest or legs. The swelling may occur for the first time after a traumatic event (such as bruises, cuts, sunburn, and sports injuries), after an infection in the part of the body that was treated for cancer, or after an extended (more than three hours) plane journey (due to the sudden change in cabin pressure)
• A "full" or heavy sensation in the arms or legs
• Skin tightness
• Decreased flexibility in the hand, wrist or ankle
• Difficulty fitting into clothing in one specific area
• Tight-fitting bracelet, watch or ring that wasn't tight before

How is lymphoedema diagnosed?

Lymphoedema is diagnosed after a careful evaluation of your medical history, including past operations and treatments, an evaluation of current medications and symptoms and a complete physical examination. Sometimes, additional tests may be needed.