Lymphoedema treatment

Lymphoedema is a side effect some people experience after breast cancer surgery or radiotherapy.

Fluid can build up under the skin and cause swelling. The condition affects the side of the body that was treated, most often the:

• arm
• hand
• breast
• chest wall.

It’s important to identify lymphoedema early, so you can prevent it from becoming worse. There is no cure for lymphoedema, but you can manage it to reduce the effect it has on your life. 

The aims of lymphoedema treatment

Treatment for lymphoedema aims to:

• reduce swelling and discomfort (and keep this improvement)
• prevent infection
• improve the movement and function of the affected area
• improve your quality of life.

Find a lymphoedema practitioner near you Australasian Lymphology Association.

If you are at risk, or see signs of lymphoedema

If you are at risk of lymphoedema, or as soon as you notice any signs, ask your treating team for advice. They may refer you to someone who specialises in lymphoedema management.

A lymphoedema specialist will do a full assessment, including:

• a physical examination
• your previous medical and surgical history
• current medications you are taking
• any other medical conditions you are having treatment for
• any relevant family history.

This information helps them develop the best treatment plan for your individual situation.

Read Reduce your risk of lymphoedema.

Treatment options for lymphoedema

There are a number of options available to treat lymphoedema. The treatment is referred to as Complex Lymphoedema Therapy (CLT) (sometimes called Complex Decongestive Therapy – CDT).

Treatment includes:

• education
• ways to care for your skin and prevent infection
• exercises to help drain fluid from your arm
• specialised massage called ‘manual lymphatic drainage’
• compression therapy to reduce swelling and improve lymph flow, which may involve a special sleeve, vest, bandage or pump. 

You may not need all these interventions. 

For example:

• mild lymphoedema: people may only need education, exercise and skin care.
• more severe lymphoedema: people may need more intensive strategies such as manual lymphatic drainage and compression therapy.

Additional test to personalise treatment

A test called ICG imaging gives detailed information about your lymph drainage patterns. This helps specialists create a personalised treatment plan for you in severe cases.

ICG imaging is ‘indocyanine green (ICG) fluorescence lymphography’. Only a few specialised lymphoedema clinics offer this test. ICG imaging is not covered by Medicare so you will have to pay a fee.

Your lymphoedema treatment plan

Your lymphoedema practitioner will develop a plan personalised to you. They consider the stage, location and severity of lymphoedema.

Lymphoedema practitioners are specially trained to manage lymphoedema and may be:

• physiotherapists
• occupational therapists
• registered nurses
• massage therapists.

They work in public and private hospitals, private clinics and individual practices.

Your practitioner will teach you techniques to manage your condition, such as massage. The aim is for you to confidently self-manage many aspects of your care.

Compression therapy

Compression therapy aims to reduce swelling and improve circulation of your lymphatic fluid. Pressure to the affected area is ‘graduated’ – it starts high and decreases.

You may use bandaging, compression garments or a pump (‘intermittent pneumatic compression’).

Compression garments

Compression garments such as a sleeve or vest are an important part of lymphoedema treatment. Your lymphoedema practitioner will help you fit them properly to reduce swelling. Find out about Compression garments for lymphoedema.

Compression bandages

Bandages or wraps may be used to reduce swelling. Your lymphoedema practitioner will apply these.

Pump (pneumatic compression)

You may use a compression pump in combination with other treatments.

The machine uses air to inflate and deflate a garment placed around the affected area. This improves the function of lymphatic vessels.

It is important a trained practitioner shows you how to use the pump. They must ensure it is at the correct pressure to avoid any damage to the tissue, which can make the lymphoedema worse.

You can use the pump at home.

For more information, speak to your lymphoedema practitioner.

Treating infections

It is important you see a doctor straight away if you have any signs of infection (‘cellulitis’). The signs are:

• the affected area becomes red or warm
• there is a sudden increase in swelling or pain
• you are generally unwell, with or without a fever. 

Good skin care is vital to reduce the risk of cellulitis. If it is not treated early, you may need to go to hospital for treatment.

The doctor may tell you to:

• start antibiotics
• lift (‘elevate’) the affected limb
• stop manual lymphatic drainage temporarily (if this is part of your routine)
• continue to use of the compression garment.

Find out ways to reduce your risk of lymphoedema, including cellulitis.

Emerging treatments

Ask your lymphoedema practitioner if you have questions about emerging treatments. We provide some details below. Some treatments may be expensive and hard to find.

Laser therapy

Studies have investigated laser therapy as a way to help soften scar tissue and improve the function of the lymphatic system.

Some evidence suggests laser therapy works well when combined with lymphatic drainage and compression therapy. Your lymphoedema therapist may recommend laser therapy as part of your treatment and suggest a particular type of handheld laser that you can use at home.

Lymph taping

A special tape called kinesio (or kinesiology) tape has been shown in some research studies to help lymph drain from the affected area.

Surgery

Surgery to treat lymphoedema  is not suitable for everyone, and results vary. Some people have significant improvement and others do not. Sometimes it involves a combination of surgeries.

Doctors may consider surgery when other therapies or treatments have not been effective. As surgery is not a cure, it is important to continue with your regular treatment after recovery.

Ongoing research is needed to see whether these techniques are effective in the long term.

Liposuction

When lymph fluid spreads into the surrounding tissues, it can stimulate fat cells to grow. Liposuction can remove the fat cells which reduces the size of the limb. This is not a cure for lymphoedema but can make you feel more comfortable.

Lymphatic bypass

A lymphatic bypass is microsurgery to create a new pathway for lymph fluid to drain. It is also called lymphaticovenous anastomosis (LVA). In this procedure, a blocked lymph vessel is joined to a vein. Results are generally better in early stage lymphoedema.

Lymph node transfer

Lymph nodes are taken (‘harvested’) from a part of the body not affected by lymphoedema. During surgery, these nodes are transferred to the affected area. They help rebuild the lymphatic system.

Drug treatments

There is little evidence of effective drug treatments for lymphoedema.

Water tablets (‘diuretics’) are not effective in reducing lymphoedema. Other medications may make lymphoedema worse.

Talk to your doctor before taking any medicines or supplements for lymphoedema. It’s important they are not harmful and do not interact with any medicines you are taking.

Private health insurance for lymphoedema treatment

Some private health insurance policies provide rebates for lymphoedema treatment. The amounts can vary, so it’s a good idea to ask your fund about your level of cover first.

You don’t always need a GP referral but some lymphoedema practitioners request it.

If your GP has created a Chronic Disease Management Plan for you, you can access up to 5 appointments with allied health professionals each year. This can include a physiotherapist or occupational therapist if they are trained in lymphoedema.

Find out about Chronic Disease Management Plans at Ways your GP can help.

Resources

Video: Understanding Lymphoedema with Professor Neil Piller (2023)

Lymphologist Professor Neil Piller explains the lymphatic system, your lymphoedema risk and what you can do to live well.

Video: Living well with lymphoedema with Maree O’Connor (2019)

Lymphoedema physiotherapist Maree O’Connor and BCNA Consumer Monique Bareham talk about what you need to know to live well with lymphoedema. They explore:

• how to reduce the risk of developing lymphoedema
• lymphoedema symptoms and how to manage them
• current and emerging treatments
• where to find help. 

Video: Understanding lymphoedema following breast cancer treatment (Part 1)

Lymphoedema experts discuss what lymphoedema is, ways to spot it and manage it. Marilyn Miller, breast cancer survivor, shares her personal experience with lymphoedema.

Video: Living with lymphoedema - the conversation continues (Part 2)

Lymphoedema experts and breast cancer survivor Wendy Mann respond to common questions and themes from part 1.

Video: Lymphoedema: fact and fiction with Professor John Boyages (2019) Professor Boyages, an internationally recognised radiation oncologist, provides an understanding of lymphoedema and dispels some of the common myths.