Conservative approaches to lymphedema treatment.

BACKGROUND

Upper extremity lymphedema can develop after surgery for breast carcinoma. Once developed, it becomes a chronic problem that women must cope with for the rest of their lives. Steps to prevent lymphedema should begin immediately after surgery. However, there is little information available about what actually causes lymphedema; therefore, it is difficult to prevent, and there is some controversy over how women should be treated once lymphedema has developed.

METHODS

The literature was reviewed to understand the education about arm care provided to women during and after the short hospital stay for breast carcinoma surgery. Evaluation and treatment options for lymphedema and complications resulting from lymphedema were explored.

RESULTS

Women are provided with basic arm care information after surgery; however, many women require reinforcement from health professionals, such as physical or occupational therapists, to reach optimum functional outcomes. If lymphedema does develop, then there are two treatment regimes that have been used. The compression pump, along with skin care, exercise, and compression garments, is one option. However, there is little consistency with the length of time the pump should be used or the optimum number of days required to receive the best results. The second treatment option is known as complex decongestive physiotherapy or complex physical therapy. Arm care, therapeutic exercises, manual lymph drainage, and compression bandages and/or garments comprise this treatment regime. Decreases in lymphedema are noted if women are compliant with the prescribed treatment program.

CONCLUSIONS

Women must be educated about possible complications after breast surgery. This should be a team effort, with physicians, nurses, physical and occupational therapists, and Reach to Recovery volunteers from the American Cancer Society all participating in the process. If women do develop lymphedema, then an individual treatment program must be established, and adherence to the program must be stressed. More research is needed to determine the optimum treatment regime for women who develop lymphedema.