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Lymphoedema after breast cancer treatment

Breast cancer treatment can cause a build up of lymph fluid. This is called lymphoedema and is pronounced lim-fo-dee-ma. Find out how you can lower your risk of getting it and how to manage it.

The lymphatic system carries clear watery fluid called lymph, which drains out from the small blood vessels (capillaries) into the body tissues.

Here is a short video to show you how the lymphatic system works:

Cancer or cancer treatment can affect the fluid drainage channels of the lymphatic system. Fluid then doesn't drain in the normal way, so the area swells.

About 1 in 5 people (20%) will have lymphoedema of the arm after breast cancer treatment that includes:

  • surgery to remove lymph nodes
  • radiotherapy to the lymph nodes

If lymphoedema is not treated, it may get worse. It can be painful and make it difficult to move your arm.

Lowering your risk of lymphoedema

Sentinel lymph node biopsy

Your surgeon might use a procedure called a sentinel lymph node biopsy (SLNB). This is when the surgeon removes the first lymph node (or first few lymph nodes). Removing the sentinel lymph nodes can cause damage to the lymph channels, so this can still cause lymphoedema. But the risk is much lower compared to removing most of the lymph nodes in the area.

Infection

Infection in a cut or graze can increase fluid collection in your arm and increase your risk of lymphoedema. There are things you can do to help protect your skin including:

  • wearing gloves when gardening or doing housework
  • using nail clippers rather than scissors
  • using an electric razor if you shave under your arms
  • take care when playing with pets
  • using insect repellent and mosquito nets to prevent bites

If you get a cut or graze, wash it well and cover it up with a plaster or dressing until it's healed.

Go to your GP straightaway if it looks red or swollen. You might need antibiotics.

Heat and sunburn

Severe heat and sunburn can increase your risk of lymphoedema. You can reduce your risk of sunburn or severe heat by:

  • wearing a sunscreen with at least SPF 15 and at least 4 stars
  • wearing suitable clothing to protect your skin from the sun such as long sleeved tops, trousers, long skirts and wide brimmed hats
  • staying in the shade during the hottest part of the day between 11am and 3pm in the UK
  • avoiding very hot baths and showers, including saunas

Take care of your skin by using a non scented moisturiser every day to keep your skin moist.

Looking after your arm

You'll get instructions on what exercises to do straight after surgery from your physiotherapist or specialist nurse. They’ll tell you what you can and can’t do after your type of surgery. You’ll have a programme that will gradually build up your arm movement and strength.

Putting too much strain on your arm after surgery can increase your risk of lymphoedema. Don't use your arm for anything heavy until your team say you can. Let your team know straight away if you develop any swelling. 

Treating lymphoedema

You should see your doctor or breast care nurse as soon as you can if you notice any swelling in your arm. Early signs and symptoms you might notice include your watch strap, rings or clothes feeling tighter. Your arm, hand or shoulder may ache or feel heavy, stiff, tight or have a feeling of fullness.

Treatment aims to reduce swelling and stop the fluid from building up again. The treatment can take a little while to show results.

You might have:

  • an elastic sleeve to wear to reduce arm swelling
  • an elasticated vest (to reduce breast swelling)
  • your arm bandaged up with a particular type of short-stretch bandage that your lymphoedema specialist puts on
  • exercises that help the fluid to drain from your arm
  • a specialised massage called manual lymphatic drainage (MLD)

You might see a lymphoedema nurse specialist for these treatments. They will measure your arm and talk to you about your symptoms.

Your nurse or lymphoedema specialist can teach you how to do gentle exercises at home to help prevent or decrease swelling in your arm. You'll get the most benefit from the exercises by wearing your sleeve when you are doing the exercises.

Heavy lifting or too much repetitive exercise could make lymphoedema worse. So be sure to stop exercising if your skin is starting to become red, hot and sweaty. 

It can be more difficult to control the swelling if you're overweight. Talk to the dietitian at the hospital or your GP if you would like some help with healthy eating tips or losing weight. 

Positioning your arm

You can help stop further swelling in your arm by positioning it carefully. Rest your arm on the table or on cushions when you're sat down.

Tips include:

  • Don't have blood taken from your affected arm.
  • Don’t repeatedly stretch your arm – for example, by hanging out washing on a clothes line.
  • Don't carry heavy shopping with your affected arm- ask for help even if it makes you feel uncomfortable.
  • Wear your watch or jewellery on the other arm.

Exercises for arm lymphoedema

Your lymphoedema specialist will show you arm exercises you can do to help your lymphoedema. They can also be useful if you are at risk of developing it.

The videos below show you how to do some exercises. Speak to your doctor or lymphoedema specialist if you are unsure about doing any of them and you should do them pain free.  These videos were made with the lymphoedema team at University College Hospital London. 

The first video shows deep breathing exercises. It is 1 minute long.

The next video is about arm exercises and is just over 4 minutes long. 

Your feelings

You may feel very angry, upset and embarrassed by the swelling in your arm. After going through treatment for breast cancer, it may feel too much to cope with lymphoedema as well.

If your arm is very swollen, it can affect your self esteem. You might feel less attractive and find it harder to go out and socialise.

If you are feeling very upset and sad about what has happened, do let someone know. Talk to someone you trust. Make an appointment to see your lymphoedema specialist nurse.

You can talk to the Cancer Research UK information nurses about living with lymphoedema on 0808 800 4040 Monday to Friday, 9am to 5pm.
Last reviewed: 
13 Jul 2020
Next review due: 
13 Jul 2023
  • Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments
    T C Gillespie and others
    Gland Surgery, 2018. Volume 7, Issue 4, Pages 379 – 403

  • Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis
    M S Asdourian and others
    The Lancet Oncology, 2016. Volume 17, Issue 9, Pages e392 to e405

  • Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis
    T DiSipio and others
    The Lancet Oncology, 2013. Volume 14, issue 6, Pages 500–515

  • Current Treatments for Breast Cancer-Related Lymphoedema: A Systematic Review
    L Li and others
    Asian Pacific Journal of Cancer Prevention, 2016. Volume 17, Issue 11, Pages 4875 to 4883

  • The Lymphoedema Support Network (LSN) Website
    Accessed July 2020

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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