Lymphedema in Breast Cancer Patients – Prevention, Treatment, Exercises, and Daily Routines

This guide focuses on evidence-based prevention, treatment, and customized exercises for swelling (lymphedema) that may occur in the arm, chest, or surrounding areas after breast cancer treatment (such as surgery, lymph node removal, or regional radiation therapy).

This information is based on standards like the Lymphology Association (2019), NCCN, and ASTRO, and is lovingly provided by Dr. Narendra Rathore (MB Hospital, Udaipur).

1. Lymphedema – Prevention Strategies

🧼 Skin Care:

• Clean the affected arm/chest daily with lukewarm water and mild soap (like Dove).

• Pat dry with a soft towel, do not rub.

• Apply moisturizer (such as Vaseline) 2–3 times a day.

• Use sunscreen (SPF 30+) or wear loose clothing.

• Consult an oncologist immediately if you notice redness, itching, or any changes.

• Keep nails short and clean; avoid getting scratched by pets.

🚫 Avoid Pressure:

• Do not wear tight clothing, jewelry, or watches on the affected arm.

• Avoid measuring blood pressure or injections in that arm.

• Do not carry heavy bags with that arm; use crossbody bags instead.

• Wear compression sleeves as prescribed during long flights or trips.

• Avoid using that arm continuously for heavy tasks; keep it light.

🛑 Infection Prevention:

• Avoid cuts, scratches, and insect bites; wear gloves when going outdoors.

• Clean minor wounds with lukewarm water and apply antiseptic (like Betadine).

• Use mosquito repellents and wear covered clothing.

• Contact a doctor immediately if you notice redness, heat, swelling, or fever.

• Avoid hot water, saunas, or steam baths.

🏋️ Avoid Heavy Lifting:

• Do not lift more than 5 kg during the first 6–12 months post-treatment.

• Use both hands for lifting heavy objects.

• Divide household chores into small intervals with rest in between.

• If repeated lifting is required, learn proper techniques from a physiotherapist.

🩺 Compression Garments:

• Wear compression sleeves (20–30 mmHg) as directed by a physiotherapist.

• Always wear them, especially during exercise.

• Multi-layer bandages may be used for significant lymphedema.

• Keep them clean daily; replace every 4–6 months.

• Use cotton liners in hot weather.

• Get medical review if you notice any skin changes due to the sleeve.

🚶 Gentle Activities:

• Practice deep breathing and shoulder rotations.

• Go for light walks (15–20 minutes) or cycling.

• Swimming may also be beneficial if approved by your doctor.

• Take deep breaths before and after exercise; avoid overexertion.

💧 Hydration and Nutrition:

• Drink 2–3 liters of water, coconut water, buttermilk, or non-acidic juices daily.

• Eat protein-rich foods (like yogurt, eggs).

• Include fruits and soups (carrot, spinach); limit salt.

• Eat small meals frequently; take protein shakes (like KABIPRO).

• Avoid: spicy, fried, or sour foods.

⚠️ Precautions:

• Follow all guidelines only after consultation with an oncologist/physiotherapist.

• Watch for early signs of lymphedema (like heaviness, tightness, or swelling) and respond promptly.

2. Lymphedema – Treatment Strategies

If lymphedema develops, timely treatment and expert care are essential.

👐 Manual Lymphatic Drainage (MLD):

• Performed by specially trained physiotherapists.

• Sessions last 30–60 minutes, 2–5 times per week depending on severity.

• Wear a compression sleeve after MLD.

• Benefits: Reduces swelling and heaviness; improves lymph flow.

• ⚠️ Note: Only undergo this massage with a trained specialist.

🩹 Compression Therapy:

• Wear 20–30 mmHg sleeves daily, especially during exercise.

• Experts may advise multi-layer bandages if needed.

• Clean daily; apply moisturizer before use.

• Benefits: Reduces swelling; aids lymphatic flow.

• ⚠️ Note: Remove sleeves at night only after consultation; avoid overly tight bandaging.

🏋️ Recommended Exercises:

• With compression sleeve on, do 10–15 minutes of light aerobic exercise 2–3 times a day.

• Benefits: Improves muscle pumping and lymph fluid movement.

• ⚠️ Note: Elevate arm for 5–10 minutes post-exercise; stop immediately if pain or swelling occurs.

🧼 Skin Care:

• Clean daily; apply moisturizers (e.g., Bepanthen).

• Consult immediately if redness, warmth, or swelling appears.

• Benefits: Prevents infection and keeps skin supple.

• ⚠️ Note: Avoid very hot or cold water; don’t use home remedies on open wounds.

💊 Medications:

• Diuretics (e.g., Furosemide) – only for severe swelling under medical supervision.

• Antibiotics/Antifungals – to treat infections.

• Pain relievers – Paracetamol, and if required, Tramadol.

• Benefits: Reduces fluid buildup and relieves pain.

• ⚠️ Note: Monitor for side effects.

🛠 Pumping Devices:

• Use compression pumps under expert supervision, for 30–60 minutes, 1–3 times a day.

• Wear compression sleeve after use.

• Benefits: Helps reduce severe swelling.

• ⚠️ Note: Do not use over infected or wounded skin.

• ⚠️ Caution: Always consult a professional before buying or using at home.

⚠️ Additional Cautions:

• Immediately contact doctor/physiotherapist if symptoms (heaviness, swelling, pain, tightness) appear.

• Manage other conditions (like diabetes) properly.

• Avoid improper treatments (incorrect massages, tight wrapping).

3. Customized Exercises

Exercise helps both in prevention and management of lymphedema. Always do them under physiotherapist supervision.

General Guidelines:

• Start slowly: Begin with 5–7 minutes, gradually increase to 15–20 minutes.

• Stay alert: Stop exercise if you feel pain, heaviness, or swelling; track symptoms.

• Use compression: Always wear a compression sleeve during exercise.

• Be consistent: Do 2–3 sessions daily, each 10–15 minutes.

• Deep breathing: Inhale deeply for 1–2 minutes at the start and end.

• Environment: Avoid hot or humid places; stay hydrated; elevate arm post-exercise.

Specific Exercises:

1. Deep Diaphragmatic Breathing

   • Place hand on stomach, inhale for 4 seconds, exhale slowly for 6–8 seconds

   • Repeat 5–8 times, for 1–2 minutes

   • Benefit: Enhances lymph flow, reduces stress

2. Shoulder Rolls

   • Rotate shoulders 10 times forward and 10 times backward

   • 2–3 times a day; 5 times for frail patients

3. Arm Lifts

   • Keep elbow straight; raise arm, hold for 10 seconds, then lower slowly

   • 5–7 repetitions, twice daily

4. Fist Pumping

   • Open and close fists, 10–15 times

   • 2–3 times daily

5. Wall Crawl

   • Use fingers to climb the wall upward, then come down

   • 5–7 repetitions

6. Gentle Yoga

   • Perform simple poses like Balasana, Kreedaa Mudra, Surya Namaskar for 10–15 minutes

   • Benefits: Enhances flexibility, lymph flow, and mental peace

⚠️ Caution: In advanced lymphedema, do yoga only under expert guidance.

📅 Regular Guidance:

• Seek ongoing advice from your oncologist or physiotherapist.

📚 Education:

• Educate the patient and family about lymphedema (e.g., through cancer.gov, Lymphology Association).

⚖ Lifestyle Suggestions:

• Maintain regular exercise, a balanced diet, and adequate rest.

🚨 Emergency:

• Seek immediate medical help for sudden swelling, redness, warmth, or fever.

📝 Important Note

Lymphedema can be prevented and managed — with timely care and professional support. Always follow expert guidance for all treatments and exercises. You are not alone in this journey — your family and medical team are always with you. ❤️