Preventing lymphoedema after breast cancer treatment

What is lymphoedema

Lymphoedema is a swelling of the arm, hand, breast or chest area on the side you had treatment. It can develop at any time after treatment for breast cancer.

Surgery to remove the lymph nodes in the armpit, or radiotherapy to these nodes, can change the way that lymph fluid drains from the arm. When fluid builds up, it causes swelling. It usually develops slowly, months or years after treatment.

Lymphoedema is more likely to happen if all or many of your lymph nodes were removed. Having radiotherapy to the armpit as well as surgery increases the risk.

You may have had only 1 or 2 lymph nodes removed. This is called a sentinel lymph node biopsy. The risk of lymphoedema is low after this. If you are not sure what type of lymph node surgery you had, your breast care nurse can tell you.

If you notice any swelling in your arm, hand or chest, ask your doctor or nurse to check it. The earlier lymphoedema is diagnosed, the easier it is to manage and treat successfully.

Reducing the risk of lymphoedema

There are things you can do to help reduce your chances of developing lymphoedema. It is important to protect your arm and hand, and to look after the skin in that area. Here are some tips:

Look after your skin

It is important to keep your skin clean and well moisturised. This reduces the risk of inflammation and infection. It is also important to protect your skin from cuts and grazes, insect bites and sunburn.

Look out for early signs of infection

See your GP straight away and let your specialist nurse know if you develop any signs of infection. Signs include having a high temperature, or your arm becoming hot, swollen or red. The redness may be harder to see in black or brown skin. It may look purple or darker than your usual skin.

Try to keep active

Regular exercise and physical activity will help encourage lymph fluid to drain. Ask your physiotherapist or specialist nurse for advice about exercise.

Keep to a healthy weight

The risk of lymphoedema is higher if you are overweight. Your GP can tell you what your ideal weight should be. You can also ask your GP or a dietitian for advice and support on eating healthily.

Using your affected arm

In the past, there was concern that having blood tests, injections or your blood pressure taken increased the risk of lymphoedema.

If you have only had a sentinel lymph node biopsy (SLNB), you can use your arm as normal.

If you have had an axillary lymph node dissection (ALND), axillary node clearance (ANC) or radiotherapy, you can have your blood pressure taken on your treated arm. You can also shave the armpit of your treated arm without increased risk.

It is best to use your untreated arm for blood tests, vaccinations, drips and cannulas where possible. You may have had surgery to both sides. In this case, you can use either arm instead of other parts of the body – as long as you do not have lymphoedema in that arm.

Take care when travelling

It is safe to fly. It can help to use a suitcase on wheels so you do not have to carry a heavy bag. Protect your skin from the sun by covering up with clothes or using suncream with a high sun protection factor (SPF). Use an insect repellent to prevent bites.

Treating and managing lymphoedema

Lymphoedema is a long-term condition. But the earlier it is diagnosed, the more effective and straightforward treatment is. If you notice any swelling in your hand, arm, chest or breast, get it checked by your cancer doctor or specialist nurse. There are different ways to help manage lymphoedema.

If lymphoedema is diagnosed, you will be referred to a specialist lymphoedema nurse, specialist breast cancer nurse, doctor or physiotherapist for an assessment. You may have to go to a specialist lymphoedema centre.

Treatment aims to reduce and control swelling, relieve discomfort and prevent more build-up of fluid.

Treating lymphoedema involves:

skin care to prevent injury and infection
exercises, including limb positioning and movement to help drain fluid
support using compression sleeves or bandages that help stop fluid from building up
self-massage or a specialised type of massage called manual lymphatic drainage.

Support from Macmillan

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line for free on 0808 808 00 00
Chat to our specialists online
Visit our life after cancer forum to talk with people who have been affected by cancer, share your experience, and ask an expert your questions.

About our information

References

Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

ESMO. Early breast cancer clinical practice guidelines for diagnosis, treatment and follow-up. 2019, Vol 30, pp1192–1220. Available from: https://www.esmo.org/guidelines/guidelines-by-topic/breast-cancer/early-breast-cancer [accessed 2023].

National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. 2018. Updated 2023. Available from: https://www.nice.org.uk/guidance/ng101 [accessed 2023].

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Rebecca Roylance, Consultant Medical Oncologist and Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.