How likely is lymphoedema after breast cancer, and can it be prevented?

What is breast cancer-related lymphoedema?

Lymphoedema is swelling caused by a build-up of lymph fluid when the lymphatic system cannot drain fluid effectively. After breast cancer treatment, surgery to remove lymph nodes from the armpit and radiotherapy can disrupt lymphatic drainage from the arm, breast or chest wall.

Early symptoms include a feeling of heaviness, tightness or fullness in the arm, rings or watches feeling tighter, and visible swelling that may come and go at first.

How common is lymphoedema after breast cancer?

A systematic review and meta-analysis of 72 studies estimated the incidence of arm lymphoedema at 16.6 per cent overall and 21.4 per cent when restricted to prospective cohort studies. Incidence appeared to increase up to two years after diagnosis or surgery 1.

Lymphoedema was about four times more common after axillary lymph node dissection (19.9 per cent) than after sentinel lymph node biopsy (5.6 per cent) 1. Lymphoedema can still develop years after treatment.

What increases the risk?

The review found strong evidence that more extensive surgery, including axillary lymph node dissection, a greater number of lymph nodes removed and mastectomy, and being overweight or obese increase the risk of lymphoedema 1.

Radiotherapy to the lymph nodes, infections in the arm and reduced activity are also discussed as possible contributors.

Is exercise safe after breast cancer surgery?

In the past, women were often advised to avoid lifting with the affected arm. A randomised trial of 154 breast cancer survivors at risk of lymphoedema, all with at least two lymph nodes removed, compared a year of slowly progressive weight lifting with no exercise. Lymphoedema developed in 11 per cent of the weight lifting group and 17 per cent of the control group 2.

Among women with five or more lymph nodes removed, lymphoedema developed in 7 per cent with weight lifting and 22 per cent without exercise 2. The key is supervised instruction and gradual progression.

How can the risk be reduced?

Maintaining a healthy weight, staying physically active and building up strength gradually are practical steps. Caring for the skin of the arm, treating cuts and insect bites promptly and seeking early treatment for signs of infection help reduce complications.

Measuring the arm before and after treatment can help detect small changes early, when lymphoedema is easier to manage. Ask your treatment team about surveillance.

How is lymphoedema treated if it develops?

International consensus describes treatment of lymphoedema with complex decongestive therapy, which combines skin care, manual lymphatic drainage, compression bandaging or garments and exercise, in a phase to reduce swelling followed by a phase to maintain the reduction 3.

Treatment is individualised, and many people manage lymphoedema long term with compression garments, exercise and self-care.

Can lymphoedema affect the breast or chest wall?

Lymphoedema after breast cancer does not only affect the arm. Swelling can also develop in the breast, chest wall, armpit or upper back, particularly after breast-conserving surgery and radiotherapy. Symptoms include heaviness, tightness, discomfort, skin thickening or a bra feeling tighter on one side.

Breast and chest wall lymphoedema can be managed with lymphatic drainage techniques, compression bras or vests, skin care and exercise. It is worth mentioning these symptoms to the care team, as they are sometimes overlooked.

When should arm swelling be checked urgently?

Seek urgent medical attention for redness, warmth, pain and swelling of the arm with fever or feeling unwell, which may indicate cellulitis, an infection that needs prompt antibiotics.

Sudden swelling with pain may also indicate a blood clot, and new swelling years after treatment should be assessed to rule out cancer recurrence.

Frequently asked questions