The surgery and treatment for breast cancer management, has changed over the past few years. More breast conserving surgery and radiotherapy seems to have increased the number of patients lymphoedema clinics are seeing with breast oedema (swelling).

Most general clinicians are familiar with the risk and development of arm lymphoedema following surgery. However, breast oedema is often assumed to be a consequence of treatment that will settle down,and as such it is not deemed to be a priority referral and may be ignored by non-specialist teams.

As specialist therapists we know breast oedema can have a significant impact not only causing physical pain & discomfort, but psychologically impacting your body image (causing problems with clothing and visual size difference) and in turn affecting your quality of life.

We know there are several factors that will increase the risk of developing breast oedema, some of which you have little control over such as:

• The type and extent of surgery required
• Amount & site of any radiotherapy
• Some chemotherapy treatments
• Post-operative complications such as infection or seroma development (pocket of fluid building up between tissue layers)

We also know from recent studies and clinical experience that a larger cup size (C+) is more likely to result in breast oedema - If you are a naturally buxom lady and within your normal weight, there is little you can do!

However, if your breast size is larger due to general weight increase, then reducing your overall body mass, will reduce breast size and improve treatment outcomes. We know an increase in weight causes problems for all types of lymphatic drainage, this applies equally to breast oedema.

How do you know if you are developing breast oedema?

The most common comments and description from patients are:

“Heaviness & ache” in the breast, marking on skin from bra seams, dimpling of the skin (resembling orange peel when the skin is pinched slightly) - usually on the underside and inner lower part of the breast, feeling of “fullness” in the breast, “puffiness” & overhanging tissue where the side bra band sits.

There may be some change to the skin colour: pink & slightly warmer skin may be present due to fluid irritating the tissues causing an inflammatory reaction.

However, if this becomes warmer, more inflamed, painful & you have a temperature or flu like symptoms, it may be an infection (cellulitis) which needs a prompt course of antibiotics from your GP.

It is important if you notice any changes, to contact your medical team sooner rather than later, so that treatment can be started to help reduce these symptoms.

Tips and Self-help

These simple self-help tips are useful in managing breast oedema. They can be started as soon as you notice any changes and while you are waiting to be seen by a specialist.

Skin Care

Daily gentle washing and drying, especially in skin folds, will prevent sore skin, fungal infection, and skin breakdown.

If you have large breasts, it sometimes helps to place a cotton handkerchief between the rib cage and breast tissue to reduce sweating and skin irritation.

Use a mild moisturising lotion and apply daily to prevent dry skin.

If you have a mild inflammation (NOT infection as discussed previously), you may find cooling gels such as aloe vera and after sun lotions helpful. The use of analgesic / anti-inflammatory gels may provide some pain relief; however, it is recommended you seek advice from your local pharmacist or GP to ensure there are no contraindications.

By carrying out regular skin care, you will become aware of any changes in the skin, especially any signs of infection (cellulitis) and be able to seek help quickly.

Exercise

Our lymphatic system moves fluid from our tissues to drainage areas around the body. To do this, we need to keep our full range of muscles active. It is therefore important to continue with the exercises you were given after your surgery.

In addition, gentle stretching and exercising in the form of yoga, pilates or swimming can be helpful, but must be within the range of your individual ability.

If you are experiencing restricted range of movement, which is not uncommon especially after radiotherapy, you may require specialist treatment, which your therapist will discuss with you.

Compression

If your breast is tender due to the oedema, you may be reluctant to wear a bra. However, if breast oedema is present, the problem is likely to worsen if the breast remains unsupported in a dependent position.

A well-fitting sports bra is a good starting point, they usually have wider straps, deeper side bands, less seams and offer good support.

It is worth considering wearing a bra, maternity sleep bra, or a soft crop top at night to prevent oedema accumulating and to provide support and comfort especially if you have a large cup size.

Once you have seen a therapist, they can advise you further & may recommend a specialist compression bra, and possibly a soft foam to use with it.

What will a specialist clinic offer as treatment?

On attending a specialist clinic or therapist they will fully examine your breast oedema & prescribe the best course of treatment.

They may have specialist equipment called a moisture meter or lymph scanner to allow them to determine exactly the extend of oedema present.

Treatment will expand on the basics of skin care, exercise & compression discussed previously, and will include some of the treatments described in this section, individualised to meet your specific needs.

Lymphatic Drainage

Manual Lymphatic Drainage (MLD) is one of the main treatments offered by specialist therapists to reduce breast oedema. It is a specific type of “massage” and is used to redirect lymphatic flow, moving fluid from an area of blocked drainage to healthy drainage routes.

A simplified version of MLD known as Simple Lymphatic Drainage (SLD), is usually taught to patients as part of a self-care programme and can be carried out by carers or partners if required.

Kinesio Tape

Kinesio tape (KT) is a medical tape often used to help reduce oedema. It improves lymphatic drainage by lifting the skin from the underlying muscle layer. This improves blood flow and lymph drainage, thus reducing oedema.

The correct application of KT must be performed and demonstrated by a trained lymphoedema specialist. However, if this treatment works for you, it is something you may be able to manage yourself, or with the aid of a relative or friend.

Low Level Laser Therapy (LLLT) or PhotoBioModulation Therapy (PBM)

This treatment involves using a special low level red light to soften fibrosis (firm oedematous tissue), reduce pain from inflammation, reduce “heaviness” and lessen oedema. It can also help improvement in scar tightness which then improves mobility.

However, the equipment is quite expensive and not all clinics will have access to this treatment.

LLLT products include the Thor Laser and the Riancorp Laser

Help from Haddenham Healthcare

Haddenham Healthcare are known for supplying equipment and compression garments for limbs, but they also have products for truncal & breast oedema.

These products range from skin care products and Kinesio tape, to compression bras and innovative compression garments such as the Comfiwave Breast Band which is due to be launched in August.