Manual lymphatic drainage (MLD)
Lymphoedema means swelling caused by a build up of in an area of the body. It can happen if lymph drainage channels or are blocked, removed or damaged. This can happen due to cancer treatments or the cancer itself.
Manual lymphatic drainage (MLD) is a specialised type of skin massage. It can help to reduce lymphoedema. Fluoroscopy guided manual lymphatic drainage (FG-MLD) is a type of MLD.
FG-MLD uses specialised massage techniques to help move lymph fluid and reduce the swelling. It is also called the ‘Fill and Flush’ method.
FG-MLD is a way of doing manual lymphatic drainage based on research that used a test to map the . Mapping the lymphatics shows how fluid:
moves through the drainage vessels just under the skin (the superficial lymphatics)
builds up in certain areas
The test can show lymph drainage pathways that work and those that don't. It can also show other drainage routes that can take over when certain channels get blocked.
Lymphoedema specialists need special training to do FG-MLD.
Before you have manual lymphatic drainage, you might have lymphofluoroscopy mapping. Other names for lymphofluoroscopy mapping include:
ICG lymphography
Near Infrared FluorescenceLymphatic Imaging (NIRFLI)
NIRF Imaging
lymphofluroscopy Imaging
ICG Fluoroscopy
Lymphofluoroscopy mapping shows up problems with the flow of lymph after lymph node treatment. Treatments like surgery or radiotherapy can change the way lymph fluid usually drains.
Although not everyone needs lymphofluoroscopy mapping of their lymphatics, it might help you to have a better response to MLD.
Your lymphoedema specialist can see the problems with your lymph flow, especially in the area where you had cancer treatment. They can then work out an individual treatment plan for you.
You have a small injection of a fluorescent dye called indocyanine green (ICG). You have it under your skin (an intradermal injection). Or you might have it into the layer of fat just under the skin (subcutaneous injection). You have 2 injections on your hand, wrist, ankle or foot. This depends on where you have swelling. The dye binds to the proteins in the lymph fluid.
The specialist then shines a special infrared camera over the swollen area. The fluorescent dye in the lymph reacts to the infrared light. In this way, the specialist can see the lymph channels. They can usually observe your lymph flow within minutes.
You then leave for several hours and exercise your arm or leg. This helps the specialist to see how far the dye has moved in your lymphatic system and shows up any blocked areas. The specialist uses a skin pen to mark where these areas are. This helps plan the MLD.
For a full mapping, you should plan to be at the appointment for anything between 4 to 6 hours.
Specialists can also use lymphofluoroscopy mapping to screen people to spot lymphoedema early. By doing this, they can diagnose swelling before you can feel or measure it and treatment can start early. This can help to control the lymphoedema well.
Mapping of your lymphatics is not available in the NHS. You can have it at a few private clinics in the UK.
You can take the results of the mapping to your lymphoedema specialist. They can use it if they've had training in FG-MLD, but it will also help them when using a different type of MLD.
Go to LymphVision to find out more about having lymphofluoroscopy mapping
Lymphoedema mapping using the ICG dye is safe and very few people have side effects. The area where you’ve had the injection will appear green afterwards and stay like that for about 2 weeks.
Your specialist will use their knowledge of FG-MLD to adapt the way they treat your swelling.
You usually lie down to have MLD. But if you have lymphoedema in your head and neck, you sit up.
When you have FG-MLD, the lymphoedema specialist uses particular hand movements to encourage the lymph fluid to drain. You feel pressure on the skin. The skin movements are firm but comfortable, slow, and rhythmic.
The number of treatments you have depends on the amount and type of swelling you have.
Researchers are studying FG-MLD to understand more about the lymphatic changes after treatments. They are looking at this in people with breast cancer who have had surgery or radiotherapy.
Other researchers want to understand more about FG-MLDs benefits.
Last reviewed: 10 Jul 2026
Next review due: 10 Jul 2029
Lymphoedema means a build up of lymph fluid that causes swelling in a part of the body. It can develop if there are problems with the lymphatic system.
Treatments to manage lymphoedema include skin care, exercise, weight management, compression therapy and manual lymphatic drainage (specialised massage).
Research helps us to find out more about conditions such as lymphoedema. Researchers are looking at what reduces the risk of developing lymphoedema and different ways of managing it.
Lymphoedema is swelling of a part of the body. It can be caused by some cancers and their treatment.
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