Managing Lymphedema

A long-term issue some breast cancer survivors contend with is a chronic swelling under the arm called lymphedema, which is caused by the removal of lymph nodes during mastectomy. Because our plastic surgeons are accomplished at microsurgical techniques, they can transfer lymph nodes from other parts of the body to alleviate this condition. Lymph node transfer can be done during breast reconstruction or at another time.

Lymph nodes are important glands that make white blood cells to fight infection. They also filter out bacteria and byproducts of infection. Because lymph nodes are susceptible to the spread of cancer, it’s not unusual for some or all of the underarm lymph nodes to be removed during a mastectomy.

When the lymph nodes are removed, swelling of the arm may occur because the normal drainage pattern of the lymph nodes is disturbed. This swelling and collection of fluid (lymphedema) can cause aching, weakness and a feeling of tightness in the affected arm.

Not every breast cancer patient who has lymph nodes removed will experience lymphedema. And the severity of the symptoms and the timing varies. Some develop lymphedema within days of surgery, and it may only last a short period of time. However, the most common type of lymphedema occurs 18 to 24 months following surgery and causes chronic problems. Some survivors note several inches of difference between their two arms as a result of the swelling.

Vascular lymph node transfer is a fairly new microsurgical procedure that helps to reduce the chronic swelling and discomfort caused by lymph node removal during mastectomy. This technique involves transferring lymph nodes from the unaffected arm or the groin to the area under the affected arm. It can be performed as a stand-alone procedure or at the same time as natural tissue breast reconstruction, which also involves microsurgery. When done with DIEP microsurgical reconstruction at MUSC Health, it only takes an extra twenty minutes.

After the procedure, patients will work with a lymphatic therapist to have arm measurements taken, learn appropriate exercises and undergo lymphatic massage as part of a larger strategy for controlling lymphedema symptoms. While lymph node transfer promises to reduce swelling and the feeling of heaviness or tightness in the affected arm, a complete “cure” of lymphedema is uncommon.