October is Breast Cancer Awareness Month

• 20,000 people are diagnosed with breast cancer each year in Australia

• Breast cancer is the 2^nd most commonly diagnosed cancer (after Prostate Cancer)

• 20% of people with breast cancer will experience lymphoedema, often in the breast or arm.

Breast lymphoedema is often a hidden condition, not obvious and able to be concealed under clothing. Patients usually suffer in silence. Many believe it is just a “normal” consequence of breast cancer treatment however it is preventable and manageable.

What is Lymphoedema?

Lymphoedema is an abnormal accumulation of protein rich fluid in the tissues, under the skin. It occurs as a result of either:

• a malformation of the lymphatic system i.e. vessels or nodes (Primary Lymphoedema)

• damage to the lymphatic system -due to cancer, surgery, radiotherapy, infection (Secondary Lymphoedema)

This affects the transport of the lymph fluid through the lymphatic system. Since the fluid is not draining as it should, it instead accumulates in the tissues and causes swelling.

Lymphoedema can occur in any part of the body, particularly the arm, leg, breast, trunk and genitals.

Lymphoedema may present at any time: soon after trauma occurs or months to years later.

Lymphoedema is a progressive disorder which if left untreated, can become a chronic condition leading to increased pain, risk of infection as well as loss of movement and mobility. This not only affects function and quality of life but can also lead to a large cost to the individual patient and healthcare systems. As a result, prevention, early detection and early intervention are paramount.

Lymphatic Drainage of the Breast

The majority of the lymph fluid from the breast drains to the axillary lymph nodes on the same side as the breast. These lymph nodes are located in the armpit. Most of the remaining breast lymph fluid usually drains to the parasternal nodes.

Signs and Symptoms

• Swelling of the breast, chest wall or armpit

• Heaviness, tightness or fullness

• Aching or pain in the swollen area

• Clothing may feel tighter e.g. bra may leave indentations in the skin

• Skin changes – pitting, thickening, hardening, peau d’orange (orange peel) appearance

Lymphoedema following breast cancer surgery may not be isolated to the breast – For those who have undergone breast surgery such as mastectomy or lumpectomy, oedema and symptoms may present around the chest wall, armpit, remaining breast tissue or arm.

Causes

• Surgery – this often includes removal of lymph nodes and/or vessels. The more lymph nodes removed, the greater the risk of developing lymphoedema. Research shows that there is a 20% chance of developing lymphoedema after an axillary node dissection compared to 5% chance with a sentinel node biopsy.

• Radiotherapy – may damage skin, remaining lymph vessels and nodes.

• Chemotherapy – some taxane based chemotherapy drugs may cause fluid retention.

• Infection – often causes an increase in fluid and can damage the skin.

• Blockage – e.g. a tumour or clot that is growing in/near a lymph node or vessel that blocks the flow of lymph fluid

Treatment

Manual Lymphatic Drainage (MLD) Massage

MLD massage is a gentle, specialised massage technique used to move lymphatic fluid away from the swollen area. The fluid is drained away from the tissues towards healthy and intact lymph vessels and nodes.

A lymphoedema therapist can also teach you how to perform a simplified version of this type of massage on yourself as part of self treatment.

Low Level Laser Therapy (LLLT)

LLLT is a safe and non-invasive technique that can be used to:

• Reduce pain

• Reduce inflammation

• Reduced oedema/swelling

• Improve blood circulation

For breast oedema, laser is often used to reduce swelling, soften and reduce skin changes and reduce pain.

Compression

Compression is used to reduce swelling, soften tissue, reduce fibrosis, prevent progression of lymphoedema or it may be prescribed to reduce the risk of onset of lymphoedema.

Some forms of compression that may be used for breast oedema include:

• Compression bras/vests

• Compression bandaging

• Intermittent Pneumatic Compression Pumps

• Pads

It is important that any bra worn, is well fitting.

Components of a good fitting bra include:

1. No underwire – It is recommended that women who have had breast surgery should NOT wear underwire bras as the wire may block the flow of lymphatic fluid.

2. Wide straps – Wide, cushioned straps should not dig into your shoulders thus impairing lymphatic flow.

3. Wide band – A wide band should not dig into your chest and around the ribs.

4. Full breast coverage – For the best support, the bra cup should contain the whole breast without any bulging at the top, bottom or sides.

Pads

Lymphoedema pads may be used to reduce swelling and help soften any fibrosed areas of the breast. These textured foam pads can usually be inserted in the bra or comfortably worn under clothing against the affected area.

Exercise

Exercise is safe for people with lymphoedema and is also an important part of treatment. Exercise can stimulate your lymphatic system. When you move and exercise, your muscles contract and create a “pumping” effect which helps to move lymphatic fluid through the lymph system.

Here are some simple exercises that can help to move breast lymphatic fluid:

• Deep breathing

• Neck rotation

• Shoulder rolls

• Arm raises

• Bicep curls

Taping

Kinesio taping is often used to help drain lymphatic fluid from the breast. This is an adhesive tape applied to the skin that aids and directs lymph fluid by lifting the skin during movement towards other areas and lymph nodes.

Skin Care

The skin is an important barrier against infection. If the skin is broken, bacteria may enter the body. Having excess lymph fluid in the arm or chest area, along with having fewer infection fighting lymph nodes can increase the risk of infection which may then cause or worsen lymphoedema.

Some ways to ensure the skin is healthy and to prevent infections include:

• Moisturising regularly to keep the skin soft and supple.

• Avoiding damage to the skin e.g. sunburn, breaks in the skin.

• Clean cuts, scratches or insect bites immediately using an antiseptic solution and cover the area with a clean dressing.

• Treat any infection immediately.

If you are concerned about breast lymphoedema or would like some more information, contact us on (02) 95538145 to book in your lymphoedema assessment. All our dedicated Lymphoedema Therapists are Registered and Accredited Lymphoedema Practitioners and members of the Australasian Lymphology Association.