Manual Lymphatic Drainage Can Put Lymphedema at Bay for Breast Cancer Patients

Photo by Kirsty Topping

Breast cancer obviously emanates fear from the core of any women who’s been diagnosed. But once acceptance allows the patient to gear up and fight the disease, they must pick themselves up again and face down the most troublesome side effects of treatment. The removal of two or three of the lymph nodes under arms and radiation damage of other nearby nodes can bring on a condition known as Lymphedema. The arms, hands, breasts, or torso may swell and cause pain and limit range of motion. But a treatment is available, and the main component involves a process known as Manual Lymphatic Drainage (MLD).

The break down of the Lymph System hinders the circulation of the protein rich lymph fluid that cycles out bacteria, viruses, and waste. As a result, the fluid does not drain properly, and the backup causes a buildup. The swelling then settles in the arms, hands, or upper body.

The condition can emerge rather inauspiciously. There are no physical change to arms, hands or upper body, but a mild tingling, unusual tiredness, or slight heaviness may be present. Stage 0 can ensue for months or years before more noticeable symptoms occur.

If the condition progresses, stage 1 will see the fluid begin to accumulate. In pressing on swollen areas, indentations or pits are left behind. The damage is not yet permanent, though.

Stage 2 exhibits inflammation, hardening, or thickening, and means that tissue damage has occurred. The affects are not reversible, but still can be managed. Stage 3 significantly swells arms and legs, but is extremely rare for breast cancer patients

In response, MLD is a massage technique that targets the lymphatic pathways and begins at the neck. The top down approach descends and facilitates drainage all along the lymphatic system.

The method involves a light touch, which does not go as deep as a typical massage. Sessions last from 20-45 minutes and work best when falling under the umbrella of Complete Decongestive Therapy. This includes compression garments worn 23 hours a day, targeted exercises, and self MLD care.

The first phase intends to drain the extra lymph fluid from the arm, hand, or upper body. Based on the reduction of swelling and improvement in other symptoms, the five day a week MLD treatment ranges from three to eight weeks.

From there, the second phase seeks to maintain progress, and may be needed for years or the rest of their lives. Of course, MLD treatment and bandage wear will lesson or increase in accordance with what the condition dictates.

At the same time, ongoing management involves an exercise regimen to control weight, protect crucial body areas, and be able to spot potential flare ups.

Either way, early intervention is a must, according Cynthia J. Shechter, who is an Occupational Therapist specializing in Breast Cancer and Lymphedema Rehabilitation. The Bergen County New Jersey based specialist sees no reason to wait for symptoms either.

Cynthia cites the broad spectrum of issues individuals face from breast cancer treatment, which includes post surgical and radiation difficulties. “Patients should be referred to a breast cancer and lymphedema rehabilitation specialist,” Cynthia responded by email.

Her main reasoning is that working with patients post-operatively takes a proactive approach in lymphedema prevention.

Otherwise, Cynthia recommends keeping a close eye for changes. “Look at your upper body in front of a mirror. Compare both sides of your body and look for changes in size, shape, or skin color. Get to know your body and what’s normal for you. This way you can spot changes and get treatment right away,” Cynthia says.

Signs may include skin changing texture, less movement or flexibility in nearby joints, trouble fitting your arm into jacket or shirt sleeves, or your bra not fitting as well. Rings, watches, or bracelets no longer fitting without weight gain can also signify a problem.

Unfortunately, the nature of the condition can mean unexpected flare ups. Nagging symptoms like pain, scarring, and limited mobility all apply and can turn everyday life into trials that the rest of take for granted. For instance, the pants or shoes worn to the office can become a real question mark, while standing or sitting too long can bring on episodes, says Cynthia, who received her certification from the Klose School for Lymphatic Education.

The looming prospect can actually overshadow the cancer for many patients, according to the Ithaca College and NYU educated healthcare professional. “I find that my patients are more distraught about their lymphedema than they are about having had a mastectomy or even breast cancer,” Cynthia says.

Symptoms aside, the implication of never-ending therapy obviously plays into the fear. So how one works a busy life around the time consuming treatment becomes daunting.

For her part, Cynthia seeks to reduce the inherent uncertainty. This means flexibility is offered to work around a patient’s schedule, and becomes a crucial element of treatment. “People seem to do better with a sense of control over their situation,” she says.

At the same time, the larger details have the medical community finding its way too. “Lymphedema is actually being studied more now than ever,” Cynthia asserts.

A 2016 NIH study, among others, confirms what professionals like Cynthia have long known. “Relevant improvement in Quality of Life was observed in the CDT group who received remedial exercises and home program in addition to compression bandage and manual lymphatic drainage,” according to the conclusions of the study authors.

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