18 Steps to Prevention

For the breast cancer patent who is at risk of lymphedema,

WHO IS AT RISK?

At risk is anyone who has had either a simple mastectomy, lumpectomy or modified radical mastectomy in combination with axillary node dissection and, often, radiation therapy.  Lymphedema can occur immediately postoperative, within a few months, a couple of years, or 20 years or more after cancer therapy.  With proper education and care, lymphedema can be avoided or, if it develops, kept under control.

The following instructions should be reviewed carefully and, if necessary, discussed with your physician or therapist.
 

1. Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers, or chest wall (consult with your doctor immediately).
    

2. Never allow an injection or a blood drawing in the affected arm(s).).
    

3. Have blood pressure checked in the unaffected arm.
    

4. Keep the edemic arm, or "at-risk" arm, spotlessly clean.  Use lotion (Eucerin, Nivea) after bathing.  When drying it, be gentle, but thorough.  Make sure it is dry in any creases and between fingers.
    

5. Avoid vigorous, repetitive movements against resistance with the affected arm (scrubbing, pushing, pulling).
    

6. Avoid heavy lifting with the affected arm.  Never carry heavy handbags or bags with over the shoulder straps.
    

7. Do not wear tight jewelry or elastic bands around affected fingers or arm(s).
    

8. Avoid extreme temperature changes when bathing, washing dishes, or sunbathing (no sauna or hot tub).  Keep arm protected from the sun.
    

9. Avoid any type of trauma (bruising, cuts, sunburn or other burns, sports injuries, insect bites, cat scratches.
    

10. Wear gloves while doing housework, gardening or any type of work that could result in even a minor injury.
     

11. When manicuring your nails, avoid cutting your cuticles (inform your manicurist).
     

12. Exercise is important, but consult with your therapist.  Do not overtire an arm at risk; if it starts to ache, lie down and elevate it.  Recommended exercises:  walking, swimming, light aerobics, bike riding and specially designed ballet or yoga.  (Do not lift more than 12 lbs.)
     

13. When traveling by air, patients with lymphedema must wear a compression sleeve.  Additional bandages may be required on a long flight. 
     

14. Patients with large breasts should wear light breast prostheses (heavy prostheses may put too much pressure on the lymph nodes above the collar bone).  Soft pads may have to be worn under the bra strap.  Wear a well fitted bra that is not to tight and with no wire support.
     

15. Use an electric razor to remove hair from axilla.  Maintain electric razor properly replacing heads as needed.
     

16. Patients who have lymphedema should wear a well fitted compression sleeve during all waking hours.  At least every four to six months, see your therapist for follow-up.  If the sleeve is too loose, most likely the arm circumference has reduced or the sleeve is worn.
     

17. WARNING:  If you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately.  An inflammation or infection in the affected arm could be the beginning of lymphedema or a worsening of lymphedema.
     

18. Maintain your ideal weight through a well-balanced low-sodium, high-fiber diet.  Avoid smoking and alcoholic beverages.  Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid; rather, this will weaken the connective tissue and worsen the condition.  The diet should contain protein that is easily digested, such as chicken and fish.