How to help prevent and control lymphedema

At this time there are no scientific studies to show that women can prevent lymphedema. Still, most experts say following these basic guidelines might lower your risk of developing lymphedema or delay its onset.

Try to avoid infection.

Your body responds to infection by making extra fluid to fight the infection. If lymph nodes and vessels are missing or damaged, it is harder for the body to move this extra fluid, which can trigger lymphedema. Good hygiene and careful skin care may reduce the risk of lymphedema by helping you avoid infections. Follow these tips to help you care for the hand and arm on the side of your body that had surgery:

• Have your blood drawn, IVs, and shots done in your unaffected arm if you can. Also get flu shots and vaccinations in your unaffected arm or somewhere else, like the hip. Tell your doctor or nurse that you are at risk for lymphedema.
• Keep your hands and cuticles soft and moist by regularly using moisturizing lotion or cream. Push your cuticles back with a cuticle stick rather than cutting them with scissors.
• Keep your arm clean. Clean and protect any skin breaks caused by cuts, scratches, insect bites, hangnails, or torn cuticles. See the section "How to care for cuts, scratches, or burns."
• Wear protective gloves when doing household chores that use chemical cleansers or steel wool, when gardening or doing yard work, and maybe when washing dishes.
• Wear a thimble when sewing to avoid needle and pin pricks to your fingers.
• Use an electric shaver to remove underarm hair; it may be less likely to cut or irritate your skin than a blade razor or hair removal cream.
• Use an insect repellent to avoid bug bites when outdoors. If you are stung by a bee in the affected arm, clean and put ice on the area, raise the arm, and call your doctor or nurse if the sting shows any signs of getting infected.
• Avoid extreme cold. It can cause rebound swelling as you warm up and chapping of your skin, which may lead to infection.

Try to avoid burns.

Like infections, burns can cause the body to make extra fluid that may build up and cause swelling when lymph nodes have been removed or damaged. Tips to avoid burns include:

• Protect your chest, shoulder, and arm from sunburn. Use sunscreen labeled SPF 15 or higher and try to stay out of the sun during the hottest part of the day.
• Use oven mitts that cover your arms.
• Avoid oil splash burns from frying and steam burns from microwaved foods or boiling liquids.
• Avoid high heat, such as from hot tubs and saunas. Do not use a heating pad on the affected areas. Heat can increase fluid build-up.

Try to avoid constriction.

Constriction or squeezing of the arm may increase the pressure in nearby blood vessels. This may lead to increased fluid and swelling (much like water building up behind a dam). Some women have linked this with the start of lymphedema. Lymphedema has also been linked with air travel, possibly because of the low cabin pressure. Tips include:

• Wear loose jewelry, clothing, and gloves. Avoid anything that forms a snug band around your arm or wrist.
• Do not use shoulder straps when carrying briefcases and purses.
• Wear a loose-fitting bra with padded straps that do not dig into your shoulder. After mastectomy, use a lightweight prosthesis (breast form). A heavy prosthesis may put too much pressure on the area.
• Have your blood pressure taken on the unaffected arm. If both arms are affected, blood pressure can be taken on your thigh.
• On long or frequent flights, wear a compression sleeve. A well-fitted compression sleeve may help prevent swelling. But careful fitting is required, since any garment that is too tight near the top can actually reduce the lymph flow. Ask your doctor or physical therapist if you should be fitted for a sleeve to wear during air travel. You may also want to discuss ways to safely raise your arm above the level of your heart and exercise it during long flights.

Try to avoid muscle strain.

It's important to use your affected arm for normal everyday activities to help you to heal properly and regain strength. This includes doing things like brushing your hair and bathing. Using your muscles also helps drain lymph fluid from the limbs. If you've had surgery or radiation treatment, ask your doctor or nurse when you can start to exercise and what type of exercises you can do. But keep in mind that overuse, which can result in injury, has been linked with the start of lymphedema in some women. It's a good idea to follow these tips:

• Use your affected arm as normally as you can. Once you are fully healed, about 4 to 6 weeks after surgery or radiation treatment, you can begin to go back to the activities you did before your surgery.
• Exercise regularly but try not to over-tire your shoulder and arm. Before doing any strenuous exercise, such as lifting weights or playing tennis, talk with your doctor, nurse, or physical therapist. They can help you set goals and limits so that you can work at the level of activity that is right for you. Ask your doctor or physical therapist if you should be fitted for a sleeve to wear during strenuous activities.
• If your arm starts to ache, lie down and raise it above the level of your heart.
• Avoid vigorous, repeated activities, heavy lifting, or pulling.
• Use your unaffected arm or both arms as much as possible to carry heavy packages, groceries, handbags, or children.

Try to avoid gaining weight.

Extra fat requires more blood vessels. This creates more fluid in the arms and chest, and places a greater burden on the lymph vessels that are left. At least 2 studies have found that gaining weight after mastectomy is linked to a higher risk of lymphedema. Women who are more overweight (obese) are more likely to have severe lymphedema.