Posted by Perry (post) on July 15, 2008, 2:08 pm, in reply to "Re: Lymphedema"
12.72.93.108
Hello Dottie and Dr. D,
Theoretically, with no nodes removed there should be no risk of lymphedema developing. But in reality, it's unfortunately not uncommon. Even prophylactic mastectomy destroys delicate lymph vessels that have little capacity to regenerate. And scarring from any surgery or other trauma further blocks lymph flow, creating a risk for the development of lymphedema (LE).
Recent research in the area of lymphology suggests that there are many factors that influence LE risk besides the number of nodes removed. Previous trauma or surgery to the chest, diabetes, other vascular conditions, genetic predisposition, overweight (especially weight gained post surgery), inflammatory response, post-surgical seroma or hematoma -- even whether the surgery was on the patient's dominant side! -- may all influence LE development. Certainly other factors not yet discovered play a role as well. So node removal and radiation, while they're damaging, are not the only determining factors. And besides arm LE, Dottie, you (and anyone treated for breast cancer) are equally at risk for breast LE, called "truncal LE."
To protect ourselves, all of us who are treated for breast cancer need to be proactive in learning risk reduction strategies. Ideally a consult with a LANA-certified LE therapist can provide a personal risk evaluation, baseline arm measurements for future reference, lessons in prophylactic lymph massage, fitting for compression sleeve and glove to be worn prophylactically for travel and exercise, and further prevention tips. Short of that, we can at least familiarize ourselves with the risk reduction practices suggested by the Position Papers at the National Lymphedema Network here: http://www.lymphnet.org
Dr. D, lymphedema is known among those of us who suffer with it as "breast cancer's dirty little secret." With your compassion and the genuine caring you show for those of us who are veterans of breast cancer, I'm hoping and trusting that you'll look into this further and take the lead in helping women avoid this disfiguring and incurable condition by alerting them to their risk and teaching them the simple life-style adjustments that can help protect them.
The National Lymphedema Network has an international conference for medical professionals next month in San Diego. Please, Dr. D, if you can't be there yourself, will you make sure that a representative from your remarkable reconstruction practice attends? There are things only YOU can do to protect us, and meeting with colleagues who share your concern for us will help to clarify the role only you can play.
Thanks so much for all you do.
Perry
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