Prevention and treatment of upper limb edema after breast cancer surgery

Upper limb edema is a common complication after breast cancer surgery. Edema is difficult to eliminate, and the problems caused by it, such as limited joint movement, limb numbness and mobility difficulties, plague many patients. Today, the editor mainly introduces some relevant knowledge about lymphedema, hoping it will be helpful to you.

How does lymphedema occur?

Upper limb lymphedema after breast cancer surgery is often caused by surgery or postoperative radiotherapy and chemotherapy, which damages the axillary lymphatic system, causing a large amount of lymph fluid to accumulate in the interstitial space, causing lymph fluid reflux obstruction in the subcutaneous tissue, and producing edema. Upper limb lymphedema is one of the common complications after breast cancer surgery. According to data, at least 20% of people will experience lymphedema after breast cancer surgery, and it mainly occurs 3 months to 3 years after surgery.

How to prevent upper limb lymphedema

Not all breast cancer patients will develop upper limb edema. After surgery, especially in the early stages, you must pay attention to the following aspects of care to prevent the occurrence of edema:

1. Prevent infection : In addition to keeping the skin on the affected side clean and safe, you should also avoid invasive operations on the affected arm, such as infusion and blood drawing. When doing housework, the affected hand should wear loose gloves and avoid prolonged contact with irritating detergents. In summer or when traveling, you should also pay special attention to avoiding mosquito bites.

2 Avoid high temperature environment : Do not use too high water temperature when bathing, avoid strong light exposure and other high temperature environments, and be sure to use hot water when doing housework to prevent burns. If the affected arm is uncomfortable, do not apply hot compresses, and ask the doctor for advice in time.

3. Pay attention to your sleeping posture and ensure the quality of sleep : when lying flat, raise the affected limb so that the shoulder and elbow are in a straight line, and the height of the palm should be higher than the heart plane; when lying on the healthy side, put a pillow under the affected limb to prop up the arm to prevent it from sagging. Relax and avoid anxiety. Good sleep can increase the excitability of the vagus nerve, activate the lymphatic system, and prevent and improve lymphedema.

4 Avoid pressure on the proximal upper limbs : avoid wearing tight clothing; when sleeping, avoid lying on the affected side, which will cause pressure or pulling on the arm. When monitoring blood pressure, avoid wearing a cuff on the affected arm.

5 Avoid weight-bearing : Avoid weight-bearing on the upper limbs within 2 to 4 weeks after surgery, and generally do not bear more than 500 grams. At all stages after surgery, until the wound heals, you need to slowly and gradually increase the activity of the affected limb to improve muscle strength and endurance, but you still need to avoid lifting, pulling, and pushing heavy objects. Try to avoid heavy physical labor or more intense sports activities. 6 Others: Restore arm function as soon as possible, and do not ignore slight swelling of the fingers, back of the hand, and upper limbs. Wear elastic sleeves when flying or traveling long distances. In daily life, insist on appropriate physical exercise under the guidance of a doctor, and avoid excessive fatigue.

It is worth mentioning that due to the particularity of the location and surgical method of breast cancer, there is often no restriction of joint movement in the early postoperative period. Some patients will habitually reach out for objects, and engage in unhealthy movements such as picking up kettles and pouring water. These are important factors that induce upper limb edema. Be sure to pay attention to avoid them, restrain your activities, proceed step by step, manage scientifically, and recover gradually.

How to treat lymphedema if it occurs accidentally?

When the early preventive management is not in place, edema still occurs as expected. At this time, there is no need to panic too much. Under the guidance of doctors, physical therapists and nurses, you should receive complex decongestion therapy (CDT) for lymphedema. The treatment includes lymphatic drainage techniques, bandage or pressure clothing treatment, health education, active exercise (coordinated with abdominal breathing, activating the diaphragm, and promoting full lymphatic return), and skin care. Lymphedema drainage is a low-pressure massage technique that stimulates the lymphatic system to promote metabolism and discharge excess fluid, protein, and metabolic waste between tissues. It must be performed by a professional therapist. In addition to increasing the motor function of lymphatic vessels and promoting fluid transfer, lymphatic drainage techniques can also act on the skin through slow and continuous techniques to reduce the activity of the sympathetic nervous system and increase the activity of the parasympathetic nervous system, thereby achieving analgesic effects.

Comprehensive detumescence treatment can be divided into two stages:

The first stage is the treatment stage , which mainly uses gentle manual lymphatic drainage to promote lymphatic return, and uses multi-layer bandages for bandaging. When bandaging, it is necessary to pay attention to using soft pads to protect the elbow, wrist joints, carpal tunnel nerves and other parts. At the same time, health education on skin care should be provided to patients to achieve the purpose of reducing the mass, volume and circumference of the affected limb;

The second stage is the maintenance stage , which mainly maintains the treatment effect through pressure bandaging, regular exercise and rehabilitation training, and appropriate weight control. Studies have shown that CDT has a significant effect on postoperative edema, upper limb function recovery, and relief of anxiety and fear in patients.