Reduce the risk of lymphoedema

Most people who have treatment for breast cancer do not develop lymphoedema, but it is important to be aware of your risk.

Understand whether you are at high or low risk and what you can do to reduce your risk.

It’s easier to manage lymphoedema if you start early, so understand what early symptoms look like.

What affects the risk of lymphoedema

The risk of developing lymphoedema is higher if you:

• have axillary clearance or axillary lymph node dissection to remove many nodes from your armpit
• have radiotherapy to your armpit, neck or lymph nodes on the same side as your surgery
• have multiple breast, armpit or lymph node surgeries
• have chemotherapy treatment that includes ‘taxane’ chemotherapy drugs
• are overweight or obese
• have an infection in your arm
• have an injury or trauma to your arm
• have a genetic condition that makes you more likely to develop lymphoedema.

The risk is lower, but not zero, if you have a sentinel node biopsy to remove lymph nodes.

Reduce your risk of lymphoedema BEFORE surgery

Before your breast cancer surgery, ask your surgeon or nurse these questions. This can help you understand your risk and ensure you manage any signs early.

• What is my risk of lymphoedema and what can I do to reduce it?
• Are you doing a sentinel lymph node biopsy (removing a few nodes) or an axillary clearance (with more lymph nodes removed and higher risk)?
• What early signs and symptoms of lymphoedema should I look out for?
• What should I do if I have any signs or symptoms?
• Can a physiotherapist or a nurse take measurements of my hands and arms before surgery to help identify any early changes?

Reduce your risk of lymphoedema AFTER surgery

After your surgery, there are ways to help reduce the risk of developing lymphoedema.

Keep active

Before you leave hospital, your treating team should show you exercises to keep your arm moving after surgery. Do all the arm and shoulder exercises your physiotherapist recommends.

Regular exercise is important. Slowly build up how much exercise you do, and how hard you exercise.

Activities such as resistance training with weights don’t make lymphoedema worse. They may even help prevent it from developing. When your muscles contract, they help push fluid through the lymphatic channels, which lowers the chance of swelling.

Use your affected arm normally for daily activities.

If you’re not sure what you should be doing, or how much, check with your physiotherapist, lymphoedema therapist or occupational therapist

Look after your body and skin

Take good care of your skin, as this can help prevent infection (‘cellulitis’). To do this:

• Moisturise your arm regularly so it doesn't become dry.
• Avoid harsh soaps or products that can dry the skin.
• Protect your skin from the sun with clothing and sunscreen.
• Use an electric razor instead of a wet razor to shave your armpit.
• Use insect repellent and, if you are bitten, use a product to stop the bite from itching.
• Wear gloves when you are washing dishes or gardening.
• Treat any cuts or breaks to the skin with antiseptic.
• If a cut, bite or break to the skin becomes red or inflamed, or if your arm swells quickly or becomes red and warm, see your doctor as soon as possible as you may have an infection that requires antibiotics.

It can also help to:

Aim for a healthy weight and a healthy diet.

Avoid tight clothes or jewellery on your affected arm or hand.

Have your bra professionally fitted.

Prepare for travel

There is no strong evidence that travel by air or long trips by car or train cause lymphoedema.

If you are planning a flight or a long journey, you can do things to reduce the risk of swelling.

• Avoid doing too much the day before.
• Do gentle exercises during your trip: clench (make a fist) and unclench your hand, with a squeeze ball if you have one
• Move your arm regularly.
• Use luggage with wheels so you don’t have to carry a heavy bag.
• Wear your shoulder bag on the opposite shoulder from the side of your surgery.
• Try to get up and walk about every couple of hours to help your general lymphatic flow.
• Wear loose-fitting clothes.
• Drink plenty of water.

For trips over 4 hours, if you have lymphoedema or are at high risk:

• Ask your lymphoedema therapist for any extra advice.
• Talk to your GP about a script for antibiotics, in case you develop cellulitis.
• Wear compression clothes such as a compression sleeve for the arm or a compression bra or vest for breast oedema.

What does not cause lymphoedema

After lymph node removal, people were historically advised to avoid medical procedures on their arm on the same side. The concern was that procedures such as injections, IVs or having blood taken could contribute to lymphoedema.

Evidence shows this advice is no longer correct. It is usually safe to use the arm on the affected side for these procedures.

The latest advice is available from the Australian and New Zealand College of Anaesthetists.