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Lymphedema Treatment and Causes

What is lymphedema?

Lymphedema is a collection of protein-rich lymphatic fluid, usually in the arm or leg. It is caused by interruption of normal lymphatic flow often due to surgery, radiation, infection or trauma. It is the protein in the fluid that makes it difficult to treat. The protein acts as a magnet for more swelling and serves as a food source for infections.

What causes it?

With normal lymphatic flow, the amount of fluid going into the arm or leg is equal to the fluid that is going out. In lymphedema, the amount of fluid going in is greater than the amount that can go out because of the damage to the “transport system”. It is sort of like the plumbing in an old house where the pipes are narrow. As long as the water is just a trickle, the plumbing can handle it. But when there is a lot of water, it goes out too slowly and backs up until it overflows.

When can it start?

Lymphedema occurs most commonly in women who have had breast surgery with removal of lymph nodes, followed by radiation therapy. It can appear weeks, months or even years after the initial surgery. It may also occur following injury or infection. In each case, normal drainage of the lymphatic fluid is interrupted.

Will it go away by itself?

Although there are cases when lymphedema has spontaneously resolved and never recurred, for most patients it is a chronic problem requiring an ongoing effort to control.

How is lymphedema treated?

A treatment plan is based on evaluation by the therapist. It may include one or more of the following elements:

Skin care: Avoidance of injury and infection, good hygiene and proper moisturization is very important. We will teach you proper skin care.

Massage: Two basic types of massage are used to treat lymphedema. Manual lymph draining is a precise and gentle form of massage that helps mobilize the fluid and direct it to other pathways. Soft tissue mobilization (or myofascial release) is a type of massage used to release scar tissue and other tightness that might be contributing to the swelling. Sometimes massage is taught to patients or family members to carry out at home.

Exercise: You may be instructed in stretching exercises to loosen up the tissues in the region or specialized exercises to help move the fluid out. You will be given written instructions for these exercises.

Bandaging: This is a precise technique which uses cotton low-stretch bandages to apply constant pressure on the limb. Bandaging is usually done in combination with other methods.

Compression Garments: These are elastic fabric garments similar to a girdle or support stocking that apply pressure to the arm or leg to help move fluid out and keep new fluid from collecting.

Medicine: Sometimes antibiotics or other medications are prescribed as part of your treatment plan.

Lymphedema Surgery

Lymphedema can often be managed with therapy and self-care. However, for many patients, surgery may help reduce the severity and symptoms of lymphedema. Surgical procedures involve bypassing the lymphatic system to drain off excess fluid and relieve swelling.

At MD Anderson, surgeons perform a lymphaticovenular bypass, a variation of lymphovenous bypass. Two to five small incisions measuring an inch or less are made in the arm or leg using tiny microsurgical tools. The surgeons redirect the lymphatic fluid to small veins (venules) to allow for drainage, thus alleviating lymphedema. The procedure takes about 2-4 hours under general anesthesia. The hospital stay is less than 24 hours.

Almost anyone suffering from lymphedema of the arm or leg is a candidate for bypass surgery. However, patients who have had the condition for a shorter time tend to have better results. Results will vary from patient to patient. Some will see a significant improvement in their lymphedma symptoms, while others may experience no improvement at all. A complete cure from lymphedema should not be expected.

While the surgery may result in significant improvement of the lymphedema, continued therapy such as wearing of the compression garment, massage, skin care and exercise is recommended to obtain the best result. Lymphedema therapy should be resumed 4 weeks after the surgery.

Insurance Coverage 

Whether or not lymphedema surgery is covered depends on your insurance company. While Medicare does not cover this procedure, many insurance companies do. Contact the Plastic Surgery Center business office for more information: 713-563-8502.

© 2015 The University of Texas MD Anderson Cancer Center