Breast Lymphoedema
11/10/24Dr Aoife McGarvey
October is Breast Cancer Awareness Month
Breast cancer treatments often involve surgery and radiation therapy, to the tumour site as well as surrounding lymph nodes in the breast and axilla. A common side effect of treatment for breast cancer is lymphoedema, which can affect the breast tissue as well as the arm. There is less awareness of breast lymphoedema compared to arm lymphoedema, so we want to shed some light on this condition during Breast Cancer Awareness month.
What is breast lymphoedema?
Swelling or “oedema” in the breast due to an accumulation of lymphatic fluid in the tissue.
Other common signs and symptoms are:
Increased size compared to the other breast. Bras and swimmers may be tricky to fit due to size discrepancy.
Tenderness. Normal activities like hugging loved ones may hurt.
Heaviness of the breast.
Skin changes such as an orange peel like appearance.
How is it caused?
Breast cancer surgery has rapidly advanced in recent years towards breast tissue conservation and reconstruction. Surgery to preserve breast tissue often involves a wide local excision and the removal of the nearest draining lymph node to send for a biopsy (sentinel node biopsy). The breast often then undergoes radiation. This creates scar tissue and frequently impairs lymphatic drainage of the breast. Breast lymphoedema may then result.
How common is breast lymphoedema?
A recent systematic review in 2021* included a total of 2155 female patients who had undergone conservative breast surgery found that - Incidence of breast lymphedema ranged from 24.8% to 90.4%!! Several risk factors were linked to breast lymphedema after conservative breast surgery, such as BMI, breast size, tumour size, tumour site, type of surgery, and adjuvant therapy (radiation and/or chemotherapy). Treatment options focused on decongestive lymphatic therapy, including.
Assessment of breast lymphoedema
Until recently there has been no accurate way to measure breast lymphoedema. Unlike the arm, you can’t compare size of the breasts accurately using a tape measure. Now however there is a brilliant little hand-held device called the LymphScanner!! This portable measuring device can detect the water content in tissue, making it very useful in the detection, monitoring and treatment of breast lymphoedema. It works by generating a high frequency electromagnetic (EM) wave which the tissue is exposed to. The reflected EM wave is registered and the obtained value is a dielectric constant, which is proportional to the water content of the measured tissue. The value increases with increased water content and lymph fluid. It is a highly accurate device so is excellent for baseline assessment, monitoring changes and the effectiveness of lymphoedema treatment.
Management
It is important to inform your treating cancer specialist before undergoing any therapy or management to confirm that your symptoms are related to breast lymphoedema. The review in 2021 found that breast lymphedema is a relatively common complication, yet there is no clear consensus on treatment options.
Management may include:
Increased size compared to the other breast. Bras and swimmers may be tricky to fit due to size discrepancy.
Manual lymphatic drainage massage.
Self-massaging.
Ensuring your bra is supportive and well-fitting.
Kinesio taping.
Hivamat Deep Vibration Oscillation (watch out for our next blog post!).
