What causes upper limb lymphedema after breast cancer surgery?
01High blood pressure
Hypertension is an independent risk factor for upper limb lymphedema after breast cancer surgery. The reason may be that water and sodium retention in hypertensive patients causes an increase in interstitial fluid and a decrease in lymphatic return function.
02Axillary lymph node dissection
Axillary lymph node dissection is recognized as the most clear and serious risk factor for lymphedema. Axillary lymph node dissection destroys the lymphatic communication channels between the upper limbs, chest wall, and neck. Therefore, patients undergoing this type of surgery are prone to poor upper limb lymphatic drainage and upper limb swelling.
03Body Mass Index (BMI)
Patients with a high BMI index are more likely to develop lymphedema. The reason is that the connective tissue of the upper limbs of obese patients is loose and the muscle contraction ability is reduced, which reduces the lymphatic return capacity. And obese patients are prone to symptoms such as fat fluid necrosis, infection, and lymphitis.
04Radiotherapy
Postoperative radiotherapy is also an important factor affecting lymphedema. Radiotherapy causes venous occlusion, lymphatic inflammation, connective tissue hyperplasia and fibrosis in the radiation field, aggravates lymphatic reflux disorders, and causes upper limb lymphedema.
Stages of lymphedema after breast cancer surgery
01Lymphedema 3-level staging method
Based on clinical symptoms, the WHO proposed a 3-level lymphedema staging system in 1992. This classification reflects the natural history of the pathophysiological development of lymphedema.
Grade I lymphedema: The edema returns to normal when the limb is elevated, indicating that there is almost no fibrosis forming under the skin.
Grade II lymphedema：The edema does not resolve spontaneously, suggesting the presence of subcutaneous fibrosis.
Grade III lymphedema: commonly known as "elephantia", characterized by keratinization and verrucous hyperplasia of the skin.
02The 4 stages of lymphedem
According to the stage of lymphedema after breast cancer surgery, it can be divided into 4 stages:
The first stage is the subclinical stage, with no obvious changes in the arm, and the patient reports a feeling of heaviness.
The second stage is mild edema, the skin is soft and non-fibrotic, and the edema subsides as the limb is raised.
In the third stage, the skin becomes fibrotic and loses elasticity, and the edema does not subside when the limb is raised.
The fourth stage is no pitting edema with thickened and rough skin.
Rehabilitation treatment of upper limb lymphedema after breast cancer surgery
At present, there are relatively few studies on lymphedema after breast cancer surgery. The main existing treatment technologies include: laser, microwave, air pressure wave and elastic bandage. Although these treatment methods can relieve the patient's limb swelling to a certain extent, they have long-term effects on the patient. The functional recovery effect is poor. Studies have shown that patients after breast cancer surgery can effectively improve the swelling of the affected limbs by wearing pressure garments for a long time without having any impact on the activities of the upper limbs, which greatly reduces the physical and mental burden of the patients after surgery.
01High blood pressure
Hypertension is an independent risk factor for upper limb lymphedema after breast cancer surgery. The reason may be that water and sodium retention in hypertensive patients causes an increase in interstitial fluid and a decrease in lymphatic return function.
02Axillary lymph node dissection
Axillary lymph node dissection is recognized as the most clear and serious risk factor for lymphedema. Axillary lymph node dissection destroys the lymphatic communication channels between the upper limbs, chest wall, and neck. Therefore, patients undergoing this type of surgery are prone to poor upper limb lymphatic drainage and upper limb swelling.
Patients with a high BMI index are more likely to develop lymphedema. The reason is that the connective tissue of the upper limbs of obese patients is loose and the muscle contraction ability is reduced, which reduces the lymphatic return capacity. And obese patients are prone to symptoms such as fat fluid necrosis, infection, and lymphitis.
04Radiotherapy
Postoperative radiotherapy is also an important factor affecting lymphedema. Radiotherapy causes venous occlusion, lymphatic inflammation, connective tissue hyperplasia and fibrosis in the radiation field, aggravates lymphatic reflux disorders, and causes upper limb lymphedema.
Stages of lymphedema after breast cancer surgery
01Lymphedema 3-level staging method
Based on clinical symptoms, the WHO proposed a 3-level lymphedema staging system in 1992. This classification reflects the natural history of the pathophysiological development of lymphedema.
Grade I lymphedema: The edema returns to normal when the limb is elevated, indicating that there is almost no fibrosis forming under the skin.
Grade II lymphedema：The edema does not resolve spontaneously, suggesting the presence of subcutaneous fibrosis.
Grade III lymphedema: commonly known as "elephantia", characterized by keratinization and verrucous hyperplasia of the skin.
02The 4 stages of lymphedem
According to the stage of lymphedema after breast cancer surgery, it can be divided into 4 stages:
The first stage is the subclinical stage, with no obvious changes in the arm, and the patient reports a feeling of heaviness.
The second stage is mild edema, the skin is soft and non-fibrotic, and the edema subsides as the limb is raised.
In the third stage, the skin becomes fibrotic and loses elasticity, and the edema does not subside when the limb is raised.
The fourth stage is no pitting edema with thickened and rough skin.
At present, there are relatively few studies on lymphedema after breast cancer surgery. The main existing treatment technologies include: laser, microwave, air pressure wave and elastic bandage. Although these treatment methods can relieve the patient's limb swelling to a certain extent, they have long-term effects on the patient. The functional recovery effect is poor. Studies have shown that patients after breast cancer surgery can effectively improve the swelling of the affected limbs by wearing pressure garments for a long time without having any impact on the activities of the upper limbs, which greatly reduces the physical and mental burden of the patients after surgery.
