When we hear of lymphedema as a
result of breast cancer treatment, we usually think of lymphedema of
the arm and hand.
In this day of sentinel lymph
node biopsy, breast conserving treatment, skin sparing mastectomies and radiation, we are seeing more and more breast and chest
lymphedema.
When the sentinel nodes are removed, the first
drainage of the breast/chest is disturbed. Unfortunately
"edema" of the breast/chest can occur in the short term,
sometimes causing pain (more common) and sometimes not.
This alone can cause lymphedema at a later time.
The addition of radiation
stiffens the tissues around the remaining lymphatic vessels, further
interrupting their ability to pump lymphatic fluid. The effects of
radiation can continue for 18 months to 2 years (or longer) causing
remodeling of scar tissue, which causes lymphedema to wax and wane
during that time.
Lymphedema of the breast and
trunk (present longer than ~ 3 months after treatment is finished)
occurs in ~ 35% of cases according to the literature. However,
because it is poorly tracked and documented, this number is probably
much higher than the literature describes.
Scar tissue left over from
surgery and radiation further interrupts the draining lymphatics of
the breast and chest wall.
So there are three reasons
for lymphatic movement to be compromised: surgery, radiation and
scar tissue. The risk increases with the amount of damage caused by
each of these treatments.
Also, in this day of
TRAM flap or DIEP flap
reconstruction,
we are seeing more chest/breast/truncal lymphedema.
Not only are the lymph nodes of the axilla disturbed/removed
(whether you have had sentinel lymph node biopsy or full axillary
dissection) but also the lymphatic vessels and drainage of the trunk has been
cut and/or disturbed.
Women and men who have
undergone a lumpectomy, mastectomy, with or without
reconstruction, are all at risk for breast/chest/truncal lymphedema.
Breast, chest
and truncal lymphedema can occur with or without arm/hand
lymphedema.
Lymphedema in the
breast/chest wall/trunk can be difficult to
diagnosis, especially if the patient does not
have lymphedema of the arm. Breast, chest and
truncal lymphedema present differently than in
the arm. Often intense pain, tenderness and a
sense of fullness and hotness, possibly
swelling, possibly not. There may be a
sense of fullness in the armpit, back, side,
breast and along the scar tissue. Although
post-operative swelling is normal, the tell tale
sign of breast/chest/truncal lymphedema is its
persistence. It does not resolve on its own
over time. For patients who have undergone
lumpectomy or reconstruction the affected breast
may be larger than it was before treatment.
Many patients will also report discomfort with
movement and activities of daily living.
Visible indentations from bra straps or seams
may be seen on the affected side, but not on the
other side. Other signs include a thickening of
the skin or hard spots of fibrosis on the
breast, chest wall or back.
Unfortunately,
our doctors are not often aware of these special areas of
lymphedema. If you feel that swelling in your
breast/chest/trunk area may be lymphedema, please ask your
healthcare provider for a referral to a
qualified
lymphedema therapist. If your doctor says it is just
post-operative swelling, but the swelling continues in your chest,
breast, trunk, do not wait. Insist on a referral to a
qualified
lymphedema therapist.
While the basic
treatment for lymphedema in these areas consists of
Manual Lymphatic Drainage Massage,
Breast
Compression, Skin Care,
Exercise
and
Patient Education,
there are some special challenges to treating
breast/chest/truncal lymphedema, and we have included these pages of
information on garments that are helpful in treating this "special"
type of lymphedema.
Please browse through these
categories. Working with your therapist, we are sure you will
find some solutions to your chest/breast/truncal lymphedema problems.
Also, please read these very
informative articles on breast/chest/truncal lymphedema:
Lymphedema Affecting the Breast and Trunk
By Joachim Zuther, on
October 5th, 2011
Breast and Trunk Oedema after Treatment for Breast Cancer
Journal of
Lymphoedema, 2006, Vol 1, No 1.
