Currently there are approximately 3 million women in America who are living through breast cancer. Treatment is highly effective with early detection, 99% of women survive the diagnosis. However, many women are unaware of the increased risk of lymphedema after breast cancer surgery. And, unfortunately, so are many massage therapists.
What is lymphedema?
"Lymphedema is a possible effect of breast cancer surgery and radiation therapy. It can appear in some people during the months or even years after treatment ends. Lymph is a thin, clear fluid that circulates throughout the body to remove wastes, bacteria, and other substances from tissues. Edema is the buildup of excess fluid. So lymphedema occurs when too much lymph collects in any area of the body. If lymphedema develops in people who’ve been treated for breast cancer, it usually occurs in the arm and hand, but sometimes it affects the breast, underarm, chest, trunk, and/or back.
Why does lymphedema happen? As part of their surgery, many people with breast cancer have at least two or three lymph nodes removed from under the arm (sentinel lymph node biopsy), and sometimes many more nodes (axillary lymph node dissection). If the cancer has spread, it has most likely moved into to those underarm lymph nodes first because they drain lymph from the breast. Many people also need radiation therapy to the chest area and/or underarm. Surgery and radiation can cut off or damage some of the nodes and vessels through which lymph moves. Over time, the flow of lymph can overwhelm the remaining pathways, resulting in a backup of fluid into the body’s tissues." - Source http://www.breastcancer.org/treatment/lymphedema
Signs of lymphedema - according to the Mayo Clinic - here are the symptoms to be aware of in the instance of lymph node removal.
Swelling of part or all of your arm or leg, including fingers or toes
A feeling of heaviness or tightness
Restricted range of motion
Aching or discomfort
Hardening and thickening of the skin (fibrosis)
The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.
Reduce lymphedema flare-up risks-
Avoid taking unusually hot baths or showers and immersing the arm and upper body in high-heat hot tubs or steam baths. If you wish to use a hot tub, keep your affected arm out of the water and limit your exposure to 15 minutes or less.
Don’t apply heating pads or hot compresses to the arm, neck, shoulder, or back on the affected side. Also, be cautious of other heat-producing treatments provided by physical, occupational, or massage therapists, such as ultrasound, whirlpool, fluidotherapy (which combines high heat and massage), or deep tissue massage. Heat and vigorous massage bring extra fluid into that area of the body.
Avoid carrying heavy objects or shoulder bags on your at-risk arm, especially with the arm hanging downward, at least initially. As you strengthen the arm over time, you should able to carry heavier objects again.
Avoid wearing tight watches, bracelets, or rings on your affected hand or arm.
Avoid wearing clothing that has tight sleeves or that restrains movement.
Avoid exercises that put great pressure on the arm — such as push-ups, the downward dog position in yoga, heavy weightlifting, or bowling — until you and your therapist determine what your arm can handle and how to build up its strength.
What does this mean for regular massage after breast cancer surgery?
Massage after breast cancer surgery can be beneficial both physically and emotionally. Physically, massage can:
● reduced anxiety in advance of surgery
● easier recovery from anesthesia
● reduced post-surgical pain
● improved moblity and appearance of surgical scars
● reduced swelling
● improved range of motion
● easier adaptation to implants and expanders
Emotionally, massage can:
● reduce anxiety
● reduce depression
● increased feelings of well-being
● being pleasantly distracted
● improved body self-image
● restored hope
● satisfaction in participating actively in a part of the healing process
For a licensed massage therapist trained in Oncology massage, special precautions are taken into consideration for lymphedema risk. If you are a regular at a local spa or your current massage therapist is not trained in oncology massage, simply tell them not to massage the extremity that is at risk - i.e. - if you've had lymph node removal on the right breast - then ask your massage therapist not to massage the right arm.
If you are considering a drastic surgery due to a genetic mark for breast cancer, then please take time to understand your options with regards to lymphedema in the future. Often, with the initial cancer diagnosis, a possible future prognosis of lymphedema is overlooked due to the immediate diagnosis and treatment options available for breast cancer. However, lymphedema can potentially decrease quality of life post surgery.
What if I already have lymphedema?
If you are already experiencing lymphedema then there are options for you. First, talk to your doctor. Physical Therapists and Occupational Therapists can bill for reimbursement for Lymphedema Therapy by using standard CPT codes as appropriate for the services rendered. Massage Therapists are usually precluded from using CPT (billing) codes and receiving reimbursement.
I suggest finding a Klose Trained Lymphatic Drainage Therapist if you are currently struggling with lymphedema. The symptoms of lymphedema can be significantly reduced by these highly trained and highly educated medical professionals.
- Chrystal B. Copeland, LMT has been practicing massage therapy in Albuquerque, New Mexico since 2009. She is trained in Oncology Massage through Tracy Walton and Associates based out of Boston, Massachusetts.