Concerned About Lymphedema After Breast Cancer Surgery? Self-Checks and What to Do About Swelling and Heaviness

Arm Swelling After Breast Cancer Treatment May Be a Sign of Lymphedema

If, after breast cancer treatment, you notice changes such as swelling in the arm on the treated side, the arm or hand feeling heavy or tired, rings or a wristwatch feeling tighter, or a sensation of skin tightness, these may be early signs of lymphedema.

Lymphedema is a condition in which impaired lymphatic flow causes lymph fluid to accumulate in the tissues beneath the skin, resulting in swelling of the arm, hand, or other areas. It can develop after lymph nodes in the armpit have been removed during breast cancer surgery or when radiation therapy has affected lymphatic flow.

However, arm swelling is not always caused by lymphedema. Temporary swelling, medication effects, inflammation, or other medical conditions may also be responsible. If swelling persists, it is important to seek medical advice early.

Why Does Lymphedema Occur After Breast Cancer Treatment?

Lymphedema can occur after breast cancer treatment because surgery or radiation therapy may affect the lymphatic vessels and lymph nodes that carry lymph fluid.

During breast cancer surgery, lymph nodes in the armpit may be removed, when necessary, to assess how far the cancer has spread. Removing lymph nodes can make it harder for lymph fluid to return from the arm to the center of the body, leading to swelling in the arm or hand on the treated side. Radiation therapy can also cause changes in the skin and lymphatic vessels within the treated area, which may affect lymphatic flow.

Lymphedema does not always develop immediately after treatment. Arm swelling or heaviness may first appear months or even years later.

Do Not Miss the Signs | Lymphedema Symptoms and Self-Checks

In the early stages, visible changes may be subtle, and lymphedema may first be noticed as a change in sensation, such as the arm feeling somewhat heavy. Recognizing these changes early can help you receive appropriate care and treatment.

Early Signs of Lymphedema to Watch For

If you notice any of the following changes in the arm or hand on the treated side after breast cancer treatment, lymphedema may be present:

・The arm or hand feels heavy or tired

・A feeling of fullness, tightness, or pulling in the arm or hand

・Rings, a wristwatch, or sleeve cuffs feel tighter

・An indentation remains for a while after pressing the skin with a finger

・Veins in the arm or bones on the back of the hand are less visible than before

・A noticeable difference in size between the two arms

Symptoms may vary by time of day, for example being milder in the morning and more pronounced in the evening. They also vary from person to person and may be difficult to judge by appearance alone.

How to Perform Self-Checks at Home

Making the following checks part of your routine can help you notice changes more easily:

・Compare both arms: Place your arms side by side and look for differences in size or skin condition at several points, including the backs of the hands, the wrists, and above and below the elbows.

・Press the skin gently with a finger: Using the pad of a finger, press the arm or back of the hand for a few seconds. If the indentation does not return to normal promptly after you release your finger, this may be a sign of swelling.

・Measure and record arm circumference: Measure the circumference of your arm at fixed points on a regular basis and keep a record. For accurate comparison, measure at the same locations and at the same time of day.

Self-checks are only a guide for noticing changes and cannot determine whether you have lymphedema. If you notice anything concerning, consult a healthcare provider early.

When to Seek Medical Advice If Lymphedema Is Suspected

Recognizing the condition early and receiving appropriate care or treatment may help slow its progression. If you are unsure, do not continue to monitor the symptoms based on your own judgment; seek medical advice early.

Seek Medical Advice Early in These Situations

Consult a healthcare provider early if you notice any of the following:

・Swelling or heaviness in the arm or hand continues for several days

・The swelling suddenly becomes more pronounced

・The difference in size between the two arms is increasing

・New changes, such as rings or sleeve cuffs feeling tight, continue

・The skin is becoming firmer or less flexible

It is important to seek care while symptoms are still mild and discuss the treatment and self-care most appropriate for your condition.

When Prompt Medical Attention Is Needed

If you have any of the following symptoms in addition to arm swelling, you may have an infection such as cellulitis. Please seek medical attention as soon as possible.

・The skin of the arm or hand is red or feels warm

・Pain in the arm

・Fever or chills

・Redness or swelling is spreading rapidly

・Marked fatigue or feeling very unwell

An arm affected by lymphedema is more susceptible to bacterial infection, and repeated infections can worsen the swelling.

Where Should You Seek Care?

Start by consulting the physician or breast surgeon at the medical facility where you received breast cancer treatment. Some hospitals have dedicated lymphedema clinics. If you would like a more specialized evaluation, appropriate options include plastic and reconstructive surgery, vascular surgery, or a specialist lymphedema clinic.

Prevention and Self-Care in Daily Life

The measures below may help reduce the risk of developing lymphedema, but they cannot guarantee prevention. Do not rely solely on your own judgment; discuss any concerns with your treating physician before incorporating these measures into your routine.

Skin Care to Keep the Skin Clean and Protected

Keep the skin clean and protect it from dryness with appropriate skin care.

・Keep the skin clean and moisturize after washing

・Take care to avoid small cuts, burns, and insect bites

・Do not scrub the skin when washing; gently pat it dry with a towel

Promote Lymph Flow with Moderate Exercise

Physical activity can support lymphatic flow. Consider gentle exercise such as walking, within a comfortable range. However, suddenly starting intense exercise may worsen symptoms. Ask your treating physician about the appropriate type and intensity of exercise.

Maintain a Healthy Weight and Avoid Tight Compression

Obesity may increase the risk of developing lymphedema, so maintaining a healthy weight can also help reduce risk. Avoid constricting the arm on the treated side with tight undergarments, clothing, or accessories.

Be Careful with Self-Directed Massage

Self-directed massage intended to “move the lymph,” as well as general massage provided at relaxation or massage salons, should be avoided. These types of massage do not prevent or treat lymphedema and may instead worsen symptoms. Manual lymph drainage used as a medical treatment is performed by trained healthcare professionals under a physician's direction and is different from ordinary massage.

Main Treatments for Lymphedema

Treatment for lymphedema can be broadly divided into conservative therapy (non-surgical treatment) and surgical treatment. The most appropriate approach depends on the severity and course of the condition, so it is important to determine the treatment plan after a medical evaluation.

Conservative Therapy (Non-Surgical Treatment)

Conservative therapy and rehabilitation form the mainstay of treatment. The following approaches are combined to promote lymph flow and help prevent swelling from worsening:

・Compression therapy: Appropriate compression of the arm using compression garments, such as sleeves, or elastic bandages

・Manual lymph drainage: A specialized technique used to promote lymph flow

・Exercise therapy: Gentle movement within safe limits to support lymph flow

・Skin care: Keeping the skin clean and moisturized to prevent skin problems

A structured combination of these approaches is called complex decongestive therapy (CDT) and is considered standard treatment. It is important to continue treatment under the guidance of healthcare professionals with expertise in lymphedema rather than trying to manage it on your own.

Surgical Treatment

Surgical treatment may be considered when conservative treatment does not provide sufficient improvement. Surgical options include reconstructive procedures that improve lymphatic flow itself and reductive procedures that remove excess tissue.

Reconstructive procedures include lymphaticovenular anastomosis (LVA), which connects tiny lymphatic vessels to veins, and lymphatic vessel transfer. Reductive procedures include liposuction and excision of fatty tissue, which aim to relieve symptoms by reducing thickened tissue.

In recent years, LVA in particular has attracted attention as an effective treatment. It may provide greater benefit when performed at a relatively early stage of lymphedema.

Frequently Asked Questions About Lymphedema After Breast Cancer Surgery

Q. Will everyone develop lymphedema after breast cancer surgery?

No. The risk is considered higher when many lymph nodes in the armpit have been removed or when radiation therapy has been given, but not everyone who undergoes breast cancer surgery develops lymphedema.

Q. When can lymphedema develop after breast cancer treatment?

If lymph nodes were removed during surgery, lymphedema can occur soon after the operation or many years later. Making self-checks part of your routine after treatment can help you notice changes in your arm early.

Q. Can lymphedema also occur in the arm on the side that was not operated on?

Lymphedema most commonly affects the arm on the side where lymph nodes were removed or radiation therapy was given. It is uncommon for breast cancer-related lymphedema to develop in the opposite arm. However, consult your treating physician about any concerning swelling, regardless of which arm is affected.

Q. Once lymphedema develops, will it never go away?

Although complete resolution can be difficult, this does not mean that nothing can be done. Continuing treatments such as compression therapy and skin care can help reduce swelling, prevent worsening, and keep symptoms under control.

Q. Is it safe to use my arm for housework or work?

There is no need to avoid normal everyday use of the arm excessively. However, it is advisable to avoid suddenly placing a heavy load on the arm, such as lifting something very heavy. If you are unsure, consult your treating physician.

Summary | Consult a Specialist About Symptoms That Concern You

Lymphedema after breast cancer treatment often begins with changes such as swelling of the arm or hand, heaviness, a feeling of tightness, or rings and sleeve cuffs becoming tighter. Although complete resolution can be difficult, recognizing the condition early and continuing appropriate treatment and self-care can help prevent worsening and keep symptoms under control.

If arm swelling or heaviness persists, or if it is accompanied by redness, warmth, or fever, do not continue to wait and see. We recommend seeking medical advice.

Reviewed by: Makoto Mihara, Naoko Hara, and Yohei Iwanaga
Lymphedema Clinic Tokyo / Board-certified plastic surgeons

At Lymphedema Clinic Tokyo, we provide care for lymphedema by combining conservative therapy, lymphaticovenular anastomosis (LVA), and lymphatic ultrasound.