The aims of treatment for lymphoedema are to encourage lymph fluid to move away from the swollen area, to try and improve the physical symptoms and to stop them getting worse. The way this is done will depend on how severe your lymphoedema is, but your treatment may include some, or all, of the following approaches at different times.
For more information you can download our booklet Living with lymphoedema after breast cancer.
The following treatments aim to control your lymphoedema.
Skincare is important because having excess lymph fluid in the arm or chest area, together with having fewer infection-fighting lymph nodes, increases the risk of infection. Small breaks in or damage to 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 and make controlling any swelling more difficult. Daily washing and moisturising will help to keep the skin supple and prevent dryness. If an infection develops it can lead to further damage to the lymph system due to scarring, and may make the lymphoedema worse.
Exercise will keep your joints supple and encourage muscle activity which 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. If you’ve been fitted with a compression garment, always wear it when you are exercising or when you are very active.
- Sport and fitness Sports and activities that you did before you developed lymphoedema and those you wish to take up now are still possible, as long as you return to/start them slowly and stop if you have any discomfort or you notice further swelling. If you want to increase your activity levels or take up a new sport, make sure you do it gradually. Research suggests that exercise is helpful when you have lymphoedema and does not make the lymphoedema worse.
- General activities Try not to use the affected arm for lengthy, strenuous activities such as lifting, carrying heavy objects or pushing heavy equipment like lawn mowers. If you need to do these activities, try to do other things in between to break up the length of time spent on them.
- Shoulder, hand and arm exercises It is important to keep your shoulder moving to avoid stiffness developing. Our leaflet Exercises after breast cancer surgery features arm and shoulder exercises for people who have had treatment for breast cancer. If you find you can’t do a movement fully or the exercises cause you pain, it’s best to stop and get advice from your lymphoedema specialist or breast care nurse. You can exercise your arm a little when you are walking around by slowly bending and straightening it. To relieve pressure and swelling in the hand, try slowly opening and closing it as if squeezing a rubber ball. Try to avoid letting your arm hang down for long periods as this can encourage the lymph fluid to collect. Your lymphoedema specialist, breast care nurse or physiotherapist may give you some specific shoulder, arm and hand exercises to encourage movement and help improve lymph drainage. If you’ve been fitted with a compression garment, it’s advisable to wear this when doing these exercises.
Maintaining a healthy body weight
Being overweight can affect how you respond to treatment for lymphoedema, so it’s important to try to keep your weight within normal limits. There’s no specific diet that will help but if you are overweight, try to follow a healthy, well-balanced eating plan and a regular exercise programme. If you’re concerned about your weight, your doctor can advise you on how to get started, or may refer you to a dietitian. You could also look at the NHS Choices website to get some ideas.
If the swelling is in your arm and/or hand you may be fitted with a compression garment in the form of a sleeve and/or glove to help control your lymphoedema. If the swelling is in your breast or chest wall area, you may be fitted with a compression bra or vest. Your lymphoedema specialist will assess which size and type of garment is best for you and this will usually be available on prescription.
Compression garments are designed to reduce existing swelling and 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.
The average life span of a compression garment is about six months, after which it loses some of its elasticity and effectiveness. Therefore, make sure you contact your breast care nurse or lymphoedema specialist to request new garments.
If you find the garment difficult to cope with, and your lymphoedema specialist has checked that it fits correctly, try wearing it when you are 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. Evidence is limited to support the use of compression garments during air flight in people with lymphoedema. However, if you have been advised to wear a compression garment, many lymphoedema specialists suggest wearing it when flying. Long flights and a lot of time when you are not moving around can have an affect on swelling.
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 at this time may cause further damage.
Several layers of bandages are put on the arm by a lymphoedema specialist or another healthcare professional who has received training to do this. Initially these can make the arm seem bigger than normal and they may feel bulky and cumbersome. The bandages may be removed and reapplied regularly. Over two to four weeks of regular bandaging the arm shape and size will change so that compression garments can be fitted to control the swelling that remains.
Mannual lymphatic drainage (MLD)
MLD is a special type of lymphatic drainage massage carried out by a trained practitioner. It can be used for any degree of swelling caused by lymphoedema but it is usually used when the swelling is severe or difficult to manage.
MLD can be particularly useful over areas where compression garments cannot easily be worn, such as the chest 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. MLD is not normally used as a treatment for lymphoedema on its own and is usually combined with other treatments.
Your lymphoedema specialist will be able to tell you if MLD may help you. This treatment is available in some NHS hospitals, Macmillan centres or privately.
Simple lymphatic drainage (SLD)
Your lymphoedema specialist may teach you a simple type of skin massage based on the principles of MLD, which aims to improve lymph drainage in areas of the body near the swelling. The movements are not carried out on the swollen area, but on areas of the body closest to this to make it easier for lymph fluid to drain away. If you find it difficult to do the skin massage yourself, someone close to you can be taught how to help you with it.
Kinesio taping method
Kinesio tape is a particular type of adhesive tape applied to the skin by a trained therapist. You can be shown by your specialist how to replace the tape. The tape lifts the skin during movement and encourages lymph fluid to move towards other areas and the lymph nodes. Kinesio tape is usually used with other forms of treatment. However, it’s sometimes used in isolation to manage lymphoedema if it develops in areas such as the breast and chest wall. It can also be used to soften and reduce hard, firm tissue (fibrosis).
The following treatments are sometimes used alongside the above to manage lymphoedema, but their benefits are less clear.
Research is currently being carried out into the use of surgery to treat lymphoedema, and it may be considered for some people. However, it is not yet widely available and results are varied.Lymphatic reconstruction
Microsurgery (lymphatic reconstruction) for lymphoedema is a relatively new procedure performed under local anaesthetic by plastic surgeons with special training in microsurgery. The aim is to make new routes by joining lymph and blood vessels, to help the lymphatic system transport more lymph fluid.
Lymph node transfer
Lymph node transfer involves removing lymph nodes from one part of the body and transferring them to the armpit area.
This is a surgical procedure in which fat is removed from the affected area. It is not generally accepted as a part of treatment for lymphoedema in the UK and is only considered in the most severe cases.
Most women will continue to wear compression garments following surgery, to control swelling.
These are specifically designed to treat lymphoedema alongside other treatments, but they should never be used without the advice and close supervision of your lymphoedema therapist. The newer, mechanical compression pumps mimic the effect of MLD by squeezing the swollen arm in a plastic sleeve that inflates and deflates at regular intervals.
Low-level laser therapy
This treatment uses a low-energy laser on the lymphatic channels to improve the flow of lymph fluid. Research into this type of treatment is ongoing, but some studies suggest it may be helpful for reducing the amount of swelling, fibrosis and pain.