Category: Breast Cancer

What is lymphedema?

Lymphedema is a accumulation of protein rich lymph fluid which lies in the space between the skin and the underlying soft tissues. It may occur with damage to any part of the lymphatic system as it occurs in removing the lymph nodes in the breast. Damage can also occur from infection, or with radiation therapy.

What are the symptoms of lymphedema?

The common symptoms of lymphedema are frequent infections or cellulitis, a full or heavy sensation in the arm, skin feeling tight, decreased flexibility in the hand, wrist or fingers, difficulty fitting into clothing in one specific area, or tightness of a ring/wristwatch/bracelet.

Why the early treatment is necessary?

When lymphedema is left untreated, fluid continues to accumulate in the arm which leads to an increase of swelling and hardening or fibrosis of the tissue. The swollen arm becomes a good culture medium for bacteria and leads to recurrent infections. If left untreated it can lead to a decrease or loss of function of the arm, skin breakdown, chronic infections and possible irreversible complications.

What are the treatment options for lymphedema?

If the cause of lymphedema is an infection, the doctor will assess for treatment with antibiotics.  The recommended treatment plan for lymphedema :

• Manual Lymph drainage (In this lymph fluid from the swollen arm is redirected by a gentle massage-like technique)
• Proper skin care and knowledge of lymphedema precautions
• Compression therapy
• Utilizes and compression garments (arm sleeves, gloves as needed)
• Exercises to assist with the movement of lymph fluid and increase joint and muscle/fascia mobility.

Who are the Patients at risk?

The patients who had undergone

• Modified radical mastectomy (Whole of the breast along with axillary lymph nodes are removed)
• Breast conservation surgery ( Tumor along with some amount of breast tissue around the tumor and axillary lymph nodes are removed)
• Axillary lymph node dissection
• Radiation to axilla
• Lymphedema can occur immediately postoperative, during radiation, within a few months, a few years or even decades or more after cancer treatment.

Just as before the surgery it is important to build a wardrobe of choices. It is important to keep a variety of styles of bras and prostheses. Multiple options will provide many different combinations that allow for choices according to your daily activity level.

*Every person heals differently and stages may vary.
Q: Why is wearing a breast prosthesis important for a post-mastectomy patient?
While recreating a pre-surgery appearance helps meet the psychological need for a positive self-esteem, the use of a breast prosthesis also serves a physiological purpose by restoring natural balance and carriage of body weight. Not wearing a breast prosthesis, can create:
• Spinal curvature
• Shoulder drop
• Balance problems
• Muscle contractual and stretching/neck and back pain
• Clothing to fit inappropriately due to chest wall variations

Q: When wearing a breast prosthesis, why is wearing a post-mastectomy bra recommended?
A pocketed post-mastectomy bra is advised because…
• The pocketed bra creates security for the prosthesis and allows the form to move with the body.
• The mastectomy bra is designed to allow a higher fit under the arm where tissue may be missing.
• The straps are set closer in the back to help balance the prosthesis weight.
• Side frames help support, anchor, and balance the band around the body.

Q: If reconstruction is planned, will a prosthesis be needed?
Since decisions related to reconstruction need not be scheduled at the time of the initial surgery, patients can choose to bridge the time with a prosthesis that maintains body alignment and provides shape to the individual profile.

Q: How often should fittings be repeated?
It is suggested that new measurements be taken as often as every 6 months until the body has stabilized. Anatomical changes may include swelling, weight loss/gain and changes in shape.

Q: When am I allowed to get new garments and/or prostheses?
Most insurances allow at least 6 new garments per year. Many insurances will say as medically necessary; which is about 8-10 per year. It is important to remember the expected lifetime of a bra is only 6 months. A silicone prosthesis can be replaced once every two
years. And a foam form can get replaced once every six months. However, everyone’s insurance is different and will need to be contacted before new garments and prostheses are provided.

Q: Do the silicone or foam prostheses trigger security alarms at airports or in retail department stores?
Silicone prostheses are not known to trigger alarm systems. However, materials used in the weighted foam prosthesis are made up of a metal/gel weight and could potentially be sensitive to security alarms. If you have a foam prosthesis just be aware that the prosthesis does contain metal. But it does not need to be a concern, it’s just important to be aware. If you are concerned a prescription from your physician can be provided.

Q: Can a silicone breast prosthesis be used in the swimming pool, hot tub, or salt water?
Many manufacturers indicate their products can be used in either a swimming pool or hot tub, but we will suggest that a specifically designed swim form be used if you are in chlorinated water regularly. Otherwise, the breast form you were provided with can be worn in a pool or hot tub. The prosthesis will need to be washed well with a mild soap and left to air dry after each use.