Lymphedema Management
At UC San Diego Health, we take a team approach to lymphedema. Our experts offer the latest options to prevent and relieve the painful swelling caused by this condition.
Our experienced physicians, surgeons and certified lymphedema therapists work with you to create a personalized plan to manage your lymphedema.
What is Lymphedema?
Lymphedema is a condition that causes swelling of a body part, usually an arm or a leg, but may also affect the face, neck, breast, abdomen or genitals. The swelling occurs when a protein-enriched fluid accumulates outside of the lymphatic system. This accumulation can occur in two ways:
Primary Lymphedema
Primary lymphedema occurs without any obvious cause. It may be present at birth due to improper development of the lymphatic system. Primary lymphedema occurs more frequently in women than men. The lower extremities are most commonly affected.
Secondary Lymphedema
Secondary lymphedema can develop as a result of surgery, radiation, infection or trauma. Specific surgeries, such as surgery for melanoma, breast, gynecological, head and neck, prostate, testicular, bladder or colon cancer, put patients at risk for developing secondary lymphedema. See Cancer Care
When to See a Lymphedema Specialist
Symptoms of lymphedema can include:
- Swelling
- Body parts feel heavy or full
- Clothing feels tight but no apparent weight gain
- Changes in skin (stiffness, redness)
- Tingling or aching
- Loss of flexibility
Lymphedema is usually confined to the area in which surgery occurred. For example, breast cancer-related lymphedema is generally found in the arm, hand and trunk.
Not sure if you have lymphedema? If you answer "yes" to any of the following questions, you may be a candidate for treatment:
- Have you had surgery for cancer of the breast, head and neck, cervix, uterus, prostate or skin?
- Have you had chemotherapy or radiation treatment?
- Does your arm, leg, face or trunk tire easily, especially with activity?
- Does your arm or leg seem larger than the other limb?
- Have you noticed discomfort at the shoulder, elbow, knee, ankle, face, neck or trunk?
- Does your skin feel too tight?
- Are the joints of your hand, knee or ankle less flexible?
- Have you had a recent infection?
- Did a recent airplane flight cause swelling or tightness in your arm or leg?
Occupational Therapy for Lymphedema
We provide comprehensive and compassionate rehabilitation services for patients with lymphedema, including:
- A home program
- Patient and family education
- Referral to community services and vendors
Complete or Complex Decongestive Therapy (CDT)
Complete or complex decongestive therapy (CDT) can be used to treat moderate to severe cases of lymphedema. All of our certified Lymphedema therapists (CLTs) are clinically trained in this non-invasive form of treatment. Treatment approaches used in CDT include:
Active range of motion, stretching and strengthening exercises. Regular exercise reduces swelling by helping lymph vessels move lymph out of the affected area.
Manual lymph drainage. A gentle, noninvasive massage technique used to reduce swelling and encourage natural drainage of the lymph (fluid in the lymphatic system). While this type of therapy can be administered by patients and their caregivers, it’s important that it is done in a very specific way (speak with your therapist prior to attempting).
Low-stretch bandaging. This is a choice treatment for moderate to severe lymphedema and is a primary component of CDT. Bandaging involves creating a soft, multilayered wrap around the affected area. One of our skilled specialists will show you proper bandage techniques so you can continue this treatment at home.
Skin care. Lymphedema disrupts your body’s local immune defense, which greatly increases your risk for infection. Vigilant skin care and good hygiene prevent infection by discouraging bacteria from collecting.
Compression garments. Compression garments are a popular treatment option for mild lymphedema, but can also be used to address moderate to severe lymphedema. Made of flexible fabric, compression garments apply the right amount of pressure to the affected area and keep lymph moving.
Compression garments should:
- Cover the entire area that's swollen
- Not be too loose or baggy
- Be comfortable
- Provide support but not be too tight
- Be tailored specifically to your body
A compression garment can be made for your arm, leg, breast, chest or genitals. They come in different grades of pressure. It’s important that the garment is fitted just for you and that the grade matches your degree of lymphedema. Our therapists will carefully examine you to ensure the right size and grade.
Lymphedema Surgery
In severe cases or when patients don't see enough improvement from therapy, surgical techniques such as lymphovenous bypass and lymph node transfer can provide relief from lymphedema.
Lymphovenous Bypass
Also called lymphaticovenous anastomosis (LVA), this procedure reroutes the lymphatic system using minimally invasive microsurgery. The lymphatic channel is connected to a tiny vein, which allows the lymphatic fluid to drain.
In some breast cancer patients, lymphedema can develop as a result of underarm lymph node removal, also known as axillary lymph node dissection.
Our surgeons can perform immediate lymphatic reconstruction at the same time the node is removed to restore the lymph connections in the arm and prevent lymphedema. This is also called lymphatic microsurgical preventive healing approach (LYMPHA). Read a news release about this procedure
Lymph Node Transfer
Also called a lymphovenous transplant, this is a minimally invasive outpatient procedure when healthy lymph nodes, usually in the abdomen, are transplanted into the area of the body where the lymphatic channel is obstructed.
Lymphedema Surgery with Breast Reconstruction
When a patient needs lymphedema treatment and breast reconstruction with flaps, the bypass or node transfer can be performed at the same time.
We participate in the Enhanced Recovery After Surgery (ERAS) program, which provides state-of-the-art care to improve our patients' experience and reduce postoperative complications.