Lymphedema treatments

At one time people believed little could be done for lymphedema, but we now know that is untrue. There are several treatments to help manage and lessen the condition.

The gold standard approach is for a trained lymphedema therapist to give “complete decongestive therapy,” which includes lymphatic drainage, wrapping with compression bandages, skin care, and lymphatic exercises. The treatment takes time, perhaps daily medical office visits for several weeks.

Basics of complete decongestive therapy (CDT)

The therapy involves multiple steps.

• Lymphatic decongestion or massage is also known as manual lymphatic drainage or MLD. It gently moves excess lymphatic fluid and protein from a swollen area such as the arm, breast, underarm, or chest wall to a part of the body where it can drain better. This helps the fluid find new drainage pathways to replace those damaged by breast cancer treatment. Unlike traditional massage, which uses strong pressure to manipulate muscles, lymphatic massage uses a very light touch to stimulate the area just below the skin.
• After lymphatic massage, the therapist may wrap the area in multiple layers of padding and “short-stretch” compression bandages. These woven bandages look somewhat like Ace bandages but stretch much less, which is very important for treating lymphedema. Compression bandages are wrapped with careful layering to help the muscles pump lymph fluid. Most people wear bandages round-the-clock during the intensive treatment.
• When swelling is under control, the therapist may switch you from bandages to an elastic compression garment, such as a sleeve, hand gauntlet, or chest garment. This is worn during the day, and bandaging or a compression garment is worn at night. Your therapist can help you get fitted correctly.
• Your therapist might also use elastic kinesio tape, which you may have seen some Olympic athletes wearing. Kinesio taping should only be done by someone trained in the technique.
• Because lymphedema swells and stretches the skin, you need proper skin care to avoid injury or infection. Your therapist will monitor your skin closely and recommend ways to clean, dry, and moisturize the affected area.
• You will be taught decongestive lymphatic exercises to do during intensive lymphedema treatment. The movements are gentler than regular exercises and promote lymphatic flow. You must wear compression bandages or garments when exercising.

Other treatments for lymphedema

Compression pumps with inflatable garments apply on-and-off pressure to move lymph fluid. Research recommends using pumps only if you also do complete decongestive therapy. Some pumps may worsen lymphedema by pushing fluid when the lymphatic system has not been decongested. If you are prescribed a pump, following the directions is very important.

Medicines and supplements do not reduce lymphedema. Diuretics, water pills that increase the amount of urine you make, do not lessen lymphatic fluid and can cause harm.

For severe cases of lymphedema, your provider may consider a surgery called lymph node transplant or lymph node transfer. In this procedure, the surgeon takes lymph nodes from your groin or abdomen and transplants them to your underarm or wrist. These procedures may help lymphedema, but few surgeons perform it and results vary. Another surgery, lymphovenous anastomosis, may also be considered for severe cases of lymphedema. This procedure builds new pathways in the arm by connecting the lymphatic vessels and the veins. Again, this procedure is only available in a few places that have trained surgeons.

The FDA cleared a laser therapy unit, for professional use, to treat the fibrosis and swelling of postmastectomy lymphedema.

Lymphedema self-care is vital

After intensive treatment reduces swelling, you must continue CDT at home. The therapist will make sure you get a garment that fits you properly. Your therapist will also teach you or a caregiver how to:

• Do lymphatic decongestion or massage
• Wrap bandages
• Wear and care for compression garments
• Exercise
• Take care of your skin and use risk-reduction tips

Your routine with lymphedema

Depending on the severity of the lymphedema, you may not need to bandage regularly at home. You may be willing to live with a small amount of swelling if that means you do not have to bandage daily. Some people bandage or wear a special night-time compression garment only at night.

Your therapist may advise that you wear a garment all day. There are different garment types, with varying amounts of pressure. With help from your therapist, make sure yours is not too tight and does not irritate your skin. A garment that’s too tight can make lymphedema worse. As treatment lessens swelling, you will need to change your garment size.

In addition to your lymphatic exercises, you may also be able to add aerobic, resistance, and stretching exercises. Wear a compression garment or bandages for all exercise. Swimming, walking, and bike riding are also good options. Some women find yoga helpful. Be sure to find out if your yoga teacher has experience teaching people with breast cancer or lymphedema. You may need to modify some poses.

Begin exercise in small doses at a slow pace. Pushing too hard can trigger or worsen lymphedema. Lifting weights is fine if you start with light loads and increase weight gradually. Stop if your arm begins to tire. If you notice pain or odd feelings in the arm on your treated side, lower the intensity of your workout.

If you are overweight, losing a few pounds can lessen the swelling. A low-salt, balanced diet can help. Talk with your healthcare team before starting any exercise or weight loss program.

Paying for lymphedema treatment

Health insurers do not always cover the cost of lymphedema treatment and supplies such as compression garments. But in January 2024, the Lymphedema Treatment Act increased Medicare coverage for compression garments and other items that many people with lymphedema use every day. These include:

• Bandages
• Wraps
• Accessories such as lining, padding, and fillers
• Additional items

Medicare also offers coverage for purchasing new compression treatment items over certain time periods, as well as replacements if they are lost or stolen. For more details, visit the Centers for Medicare & Medicaid Services website to read about Medicare-covered lymphedema compression treatment items.

Medicare coverage laws often influence what other insurers, such as Medicaid and private insurance companies, are willing to cover. If you have been diagnosed with lymphedema and have health insurance other than Medicare, call your insurer to find out what lymphedema treatments and supplies are covered.

If you are experiencing challenges paying for lymphedema treatment or other kinds of breast cancer-related treatment, visit the LBBC Financial matters section for resource and support information.