Lymphedema After Breast Cancer: Recognising the Signs and Managing the Condition

When a malignancy is diagnosed, the immediate priority is naturally to treat the cancer. As a result, the focus often remains on surgery, chemotherapy, radiation therapy and other cancer-directed treatments. But certain cancer treatments, like those for breast cancer, can also affect a system in your body you may not have thought much about before: your lymphatic system. The lymphatic system is a network of vessels and lymph nodes that helps drain excess fluid and supports your body's immune function. In some people, cancer treatment can have potential long-term side effects, and can lead to lymphedema, a condition that causes persistent swelling, most commonly in the arm or hand on the side where breast cancer treatment was performed.

Breast cancer-related lymphedema (BCRL) affects roughly 1 in 5 people treated for breast cancer, although the likelihood of developing it varies depending on the type of surgery, whether lymph nodes were removed, and if radiation therapy was part of the treatment plan. While lymphedema cannot always be prevented, recognising it early and starting treatment promptly can help control symptoms, slow its progression and improve quality of life. Understanding your risk, recognizing early symptoms, and knowing what steps to take can help you stay ahead of this condition rather than react to it after it has progressed.

What is lymphedema?

Your lymphatic system is a network of lymph vessels and lymph nodes that helps maintain fluid balance in the body while supporting the immune system. Lymph nodes act as filters, removing bacteria, waste products and other unwanted substances from lymph fluid before it returns to the bloodstream.

Breast cancer treatment may involve removing lymph nodes or exposing them to radiation. When this happens, the normal drainage of lymph fluid can be disrupted. Instead of flowing through the lymphatic vessels, the fluid accumulates in the surrounding tissues, leading to swelling. This condition is known as lymphedema.

Breast cancer-related lymphedema (BCRL) is a form of secondary lymphedema, meaning it develops because a previously healthy lymphatic system has been damaged. Unlike primary lymphedema, which is present from birth due to developmental abnormalities of the lymphatic system, secondary lymphedema occurs as a result of surgery, radiation therapy, infection or trauma.

Why breast cancer treatment can lead to lymphedema

Not everyone treated for breast cancer develops lymphedema. However, certain treatments can interfere with the normal function of the lymphatic system and increase the risk.

Axillary lymph node dissection (ALND): This procedure removes several lymph nodes from the armpit to determine whether cancer has spread. Because more lymph nodes are removed, the risk of lymphedema is higher.

Sentinel lymph node biopsy (SLNB): Only the first few lymph nodes most likely to contain cancer cells are removed. Although the risk is lower than with ALND, lymphedema can still occur.

Radiation therapy: Radiation to the breast, chest wall or underarm can cause scarring within the lymphatic channels, making it more difficult for lymph fluid to drain normally.

Combined treatment: Undergoing both lymph node surgery and radiation therapy increases the likelihood of developing lymphedema compared with either treatment alone.

The extent of treatment required depends on the stage and characteristics of the cancer. Your treating team will always balance effective cancer treatment with the need to minimise long-term complications whenever possible.

Who is at higher risk

The likelihood of developing breast cancer-related lymphedema varies from person to person. Several factors influence this risk, including the removal of a larger number of lymph nodes and more extensive surgery involving the underarm (axilla). Radiation therapy to the axilla or chest wall can further increase the likelihood of developing this condition, as can infection or delayed wound healing after surgery, and the formation of scar tissue around the treated area.

Having one or more of these risk factors does not necessarily mean that lymphedema will develop. Many people complete breast cancer treatment without experiencing persistent swelling. However, understanding your individual risk helps you monitor for early signs and begin treatment promptly if needed.

When lymphedema can appear

BCRL doesn't always appear right away. While some swelling shortly after surgery is normal and usually resolves on its own, true lymphedema can develop from anywhere within the first few months after treatment to one to three years after treatment and, in some cases, five, ten or more years later.

This is sometimes called the latency period. Because BCRL can emerge long after treatment ends, ongoing awareness rather than just short-term monitoring is important for anyone who has had lymph node surgery or radiation.

Recognizing early signs and symptoms

Early diagnosis offers the best opportunity to control lymphedema and prevent it from progressing. For people who have undergone breast cancer treatment involving lymph node surgery or radiation therapy, it is important to be aware of subtle changes in the affected arm.
Symptoms may include:

• A feeling of heaviness, tightness or fullness in the arm, hand or fingers
• Swelling affecting part or all of the arm, hand or fingers
• Rings, watches, bracelets or sleeves feeling tighter than usual
• Aching, discomfort or a tingling sensation in the affected limb
• Tight, firm or thickened skin
• Reduced flexibility or stiffness in the wrist, hand or fingers

It's easy to dismiss these symptoms, especially soon after surgery when some swelling is expected. However, swelling that persists, worsens over time or is accompanied by discomfort should not be ignored. Early-stage lymphedema often responds much better to treatment than lymphedema that has been present for months or years. When in doubt, it's worth having it checked.

How lymphedema is diagnosed

Lymphedema is diagnosed through a combination of your medical history, physical examination and objective measurements of the affected limb. Your doctor will also consider the type of breast cancer treatment you received and when your symptoms began.

Several methods may be used to assess swelling and monitor changes over time:

Circumferential limb measurements: The circumference of both arms is measured at specific points to identify differences in size.

Perometry: This specialised optical scanning system uses infrared light to calculate limb volume with a high degree of accuracy.

Bioimpedance spectroscopy (BIS): A small electrical current is passed through the limb to detect early fluid accumulation, sometimes before swelling becomes clinically apparent.

Whenever possible, many specialists recommend obtaining a baseline arm measurement before breast cancer surgery. Comparing future measurements with this baseline allows even small changes to be detected at an early stage, often before noticeable symptoms develop.

Lymphedema is commonly classified into stages ranging from Stage 0, where lymphatic damage has occurred without visible swelling, to Stage 3, where significant swelling and skin changes are present. Staging helps determine the most appropriate treatment plan.

Treatment options

Although lymphedema is a chronic condition, it can often be managed successfully. Treatment aims to reduce swelling, improve limb function, lower the risk of complications and help maintain quality of life. Early treatment generally produces the best outcomes.

Complete Decongestive Therapy (CDT)
Complete Decongestive Therapy is widely regarded as the cornerstone of lymphedema treatment. It is delivered by a trained lymphedema therapist and combines several approaches to improve lymphatic drainage and control swelling.
Treatment typically includes:

Manual lymphatic drainage (MLD): A specialised hands-on technique that encourages lymph fluid to move towards healthy drainage pathways.

Compression therapy: Compression bandages or garments help reduce swelling and limit the re-accumulation of lymph fluid.

Exercise: Structured exercises activate the muscles, which assist the movement of lymph fluid through the lymphatic system.

Skin and nail care: Good skin care reduces the risk of infection, particularly cellulitis, which is more common in areas affected by lymphedema.

Compression Garments
Once swelling has been reduced, most people are advised to wear a properly fitted compression sleeve, and in some cases, a glove or gauntlet. These garments help maintain the results achieved during treatment and reduce the likelihood of swelling returning.

A compression garment should always be professionally fitted. A garment that is too loose may not provide sufficient support, while one that is too tight can interfere with circulation and cause discomfort.

Exercise
Exercise was once thought to worsen lymphedema, but current evidence shows that appropriately supervised physical activity is both safe and beneficial for most people with, or at risk of, breast cancer-related lymphedema.

Gentle stretching, range-of-motion exercises and gradually progressive resistance training can improve mobility, muscle strength and lymphatic drainage. Before beginning a new exercise programme, it is advisable to discuss it with your treating doctor or lymphedema therapist.

Surgical Treatment
Surgery may be considered for selected patients whose symptoms persist despite appropriate conservative treatment. These procedures are performed in specialised centres by surgeons trained in microsurgical techniques.

Common surgical options include:

Lymphaticovenous Anastomosis (LVA): Tiny lymphatic vessels are connected directly to nearby veins, allowing lymph fluid to bypass blocked channels and drain more effectively.

Vascularised Lymph Node Transfer (VLNT): Healthy lymph nodes are transplanted from another part of the body to help restore lymphatic drainage in the affected limb.

Surgery is not suitable for everyone. The choice of procedure depends on the stage of lymphedema, the condition of the lymphatic system and the individual's overall health.

Living well with lymphedema

For many people, lymphedema becomes a long-term condition that requires ongoing management. While it may not be possible to reverse the underlying damage to the lymphatic system, appropriate treatment and healthy daily habits can help control symptoms and reduce the risk of complications.

Take care of your skin. Keep the skin clean and moisturised to prevent dryness and cracking. Even minor cuts, burns or insect bites can increase the risk of infection. Wear gloves while gardening or doing household chores that may injure the skin.

Watch for signs of infection. Redness, warmth, increasing pain, swelling or fever may indicate cellulitis and require prompt medical attention.

Stay physically active. Regular movement encourages lymphatic drainage and helps maintain flexibility and strength. Avoid prolonged periods of inactivity, but stop and seek medical advice if swelling suddenly worsens.

Maintain a healthy body weight. Excess body weight is associated with an increased risk of developing lymphedema and may make existing symptoms more difficult to manage.

Elevate the affected arm when resting, particularly if swelling increases after activity.

Wear compression garments as advised by your doctor, especially during exercise, long-distance travel or activities involving repetitive arm movements.

Your doctor or lymphedema therapist may also recommend periodic follow-up visits to monitor your progress and adjust your treatment plan if required.

What to ask your doctor

Because early intervention leads to the best outcomes, don't wait for significant swelling to bring up lymphedema with your doctor. Consider asking:

• Am I at risk of developing lymphedema based on my treatment plan?
• Can a baseline arm measurement be performed before surgery?
• What early symptoms should I watch for after treatment?
• Should I meet a certified lymphedema therapist before symptoms develop?
• What treatment options are available if lymphedema occurs?
• Will I require long-term follow-up or compression therapy?

Having these discussions early can help you recognise changes promptly and seek treatment before symptoms become more advanced.

Why choose RIVEA for lymphedema care?

At RIVEA Vascular Institute, lymphedema care is led by Dr. Syed Mohammed Ali Ahmed, Chief Vascular Surgeon, one of the few surgeons in India with dedicated training in lymphatic disease surgery. With advanced expertise gained in India and Singapore, he specialises in the diagnosis and management of complex lymphatic disorders, combining evidence-based treatment with personalised care. Whether lymphedema develops after breast cancer treatment or from other causes, patients at RIVEA benefit from specialised vascular expertise and a comprehensive approach focused on improving long-term quality of life.