Breast Cancer Care

What treatments are available?

The aim of treatment for lymphoedema is to encourage lymph fluid to move away from the tissues by making the lymph vessels work harder. The way this is done will vary depending on how severe your lymphoedema is but your treatment will include some, or all, of the following approaches at different times. You can do quite a lot of these things yourself alongside any professional treatment you are having.

Skin care

Skin care is important because lymph fluid in the arm, together with a decrease in infection-fighting lymph nodes, means infections are more likely. Small breaks in the skin or some skin conditions which cause the skin to become red and sore can become a site for infection. Dry, flaky or cracked skin can also lead to infection. If an infection develops it can lead to further damage in the lymph channels through scarring and eventually make the lymphoedema worse.

Exercise

Exercise will keep your joints supple and is very important for lymph drainage. Although you may already use your arm actively in your everyday life or work and get plenty of exercise in this way, swelling can sometimes restrict movement of the arm and extra exercises may be helpful.

• Sport and fitness
  Sports and activities that you did before you developed lymphoedema should still be possible as long as you return to them slowly and stop if you have any discomfort or you notice further swelling.
• General activities
  Try not to use the arm for lengthy, strenuous activities such as lifting, carrying heavy shopping, or pushing heavy equipment like lawn mowers and full shopping trolleys.
• Shoulder exercises
  It is important to keep your shoulder moving to avoid stiffness developing.
• Hand and arm exercises
  You can exercise your arm a little when you are walking around by opening and closing your fist. Try to avoid letting your arm hang down for long periods as this can encourage the lymph fluid to collect. 
• Maintaining a healthy weight
  Being overweight can affect how you respond to treatment for lymphoedema so it is important to try to maintain a healthy body weight by trying to follow a healthy eating plan.

Compression garments

You may be fitted with a compression garment in the form of a sleeve or glove to help control your lymphoedema. Compression garments are designed to prevent further swelling by encouraging lymph fluid to drain away from the affected arm. The garment provides a firm resistance against which the lymph vessels are squeezed by the muscles during activity. This allows the lymph fluid to move up the arm more effectively. Wearing the garment may feel quite strange at first but it should feel comfortable and supportive. You will normally be provided with two garments so that one can be washed while the other is being worn.

If you find the garment difficult to cope with, and your lymphoedema specialist has checked that it is the correct size, try wearing it when you are at your most active and then take it off when you are least active. The compression garment is most useful when your muscles are working actively and least useful during rest. However, always wear your garment when flying as the change in pressure can affect your swelling.

Compression bandages

Compression bandages are used when the swelling has made the limb a difficult size or shape for compression garments to be fitted. They are also used if the skin has become damaged and sore as using compression garments may cause further damage.

Several layers of bandages are put on the arm by a lymphoedema specialist or another healthcare professional who has received appropriate training to do this. Initially these can make the arm seem bigger than normal and they may feel bulky and cumbersome. The bandages are removed and reapplied daily. Over two to three weeks of daily bandaging the arm shape and size will change so that compression garments can be fitted to control the swelling that remains.

Manual lymphatic drainage (MLD)

MLD is a specialised type of massage carried out by a trained therapist. It can be used for any degree of swelling caused by lymphoedema but it is usually used when the swelling is severe or complicated in some way.

MLD can be particularly useful over areas where compression garments cannot easily be worn, such as the breast area. The MLD therapist uses specialised hand movements to stimulate lymph drainage and move lymph fluid away from areas where it has collected.

It is a slow, rhythmical treatment that takes time to complete and must be carried out by a trained practitioner. MLD is not normally used as a treatment for lymphoedema on its own and is usually combined with other treatments to achieve a better result.

Simple lymphatic drainage (SLD)

Your lymphoedema specialist may teach you a simple type of massage based on the principles of MLD which aims to improve lymph drainage in areas of the body near the swelling. The swollen arm is not massaged when using this technique but massaging areas near the swelling makes it easier for the lymph fluid to drain away from the arm. If you find it difficult to do the massage yourself, someone close to you can be taught how to help you with it.