Breast Care A-Z · Condition · LYMPHOEDEMA

Lymphoedema

also: lymphedema, lymphatic swelling, arm lymphoedema, breast lymphoedema · pronounced lim-fo-DEE-ma

Lymphoedema is long-term swelling — usually of the arm or hand — that can develop when lymph drainage is disrupted by lymph-node surgery or radiotherapy. You may be deciding what kind of axillary surgery to have, recovering and wondering what to watch for, or noticing swelling and wondering whether to be concerned.

Quick answers

Will I definitely get lymphoedema after axillary surgery?

No. Most patients do not develop lymphoedema. The risk depends on the type of operation, whether radiotherapy is given, and individual factors. Around 1 in 5 patients having full axillary clearance, and around 1 in 10 to 1 in 20 having sentinel biopsy alone, develop some degree of lymphoedema over their lifetime — and most cases are mild.

Can I exercise normally after breast cancer surgery?

Yes — and you should. Exercise is protective against lymphoedema, not a cause of it. Specific guidance is given by physiotherapy after the operation, and most patients return to their usual activity (including weight training, swimming, racquet sports, golf) over the course of a few months.

What should I do if I notice swelling in my arm?

See your breast care nurse or specialist team promptly. Early assessment of new arm swelling — even if it turns out to be nothing — is the right approach. Lymphoedema picked up early responds well to compression and physiotherapy; later intervention is harder.

ONCOLOGY · POST-TREATMENT COMPLICATIONS PLATE LII lymphoedema breast cancer-related lymphoedema · BCRL chronic swelling of the arm and hand caused by disruption of axillary lymphatic drainage following surgery or radiotherapy Encyclopaedia of the Breast · Breastory · clinically authored FIG 01 Arm Comparison — Normal vs Lymphoedematous NORMAL ARM LYMPHOEDEMATOUS ARM axilla pitting oedema ALND / RT site Callouts i disrupted axillary lymph nodes (post-ALND or RT at axillary roof) ii lymphatic obstruction point — drainage impaired proximal to blockage iii interstitial fluid accumulation — protein-rich oedema in subcutaneous tissue iv pitting oedema of hand/wrist — digital pressure leaves impression v skin changes — thickening, fibrosis, cellulitis risk increased in chronic lymphoedema Risk Factors · ALND (15–25% risk) · Axillary radiotherapy · BMI >30 · Infection / cellulitis episodes · High lymph node count removed (>10) Delay in treatment increases severity ISL Staging Stage 0 — subclinical / latent (no visible swelling) Stage 1 — reversible pitting oedema Stage 2 — non-pitting, fibrosis begins Stage 3 — elephantiasis (severe fibrosis) Progression non-linear; early CDT prevents advance ISL = International Society of Lymphology FIG 02 SLNB vs ALND — Lymphoedema Risk Comparison Feature SLNB ALND Lymphoedema risk <5% 15–25% Onset Months–years post-op Weeks–months post-op Severity Usually mild Can be severe Reversibility Often reversible (Stage 1) Less reversible (fibrosis) Axillary RT added Increases risk Further increases risk Prevention CDT, exercise, weight management CDT, compression garment Treatment MLD + compression MLD + compression Impact on quality of life Mild Significant Measurement Circumference / bioimpedance Same Bilateral occurrence Rare Rare Long-term outcome Good with early CDT Requires lifelong management FIG 03 Lymphoedema Treatment Options Treatment Description Evidence MLD Manual lymphatic drainage massage High Compression bandaging Multi-layer short-stretch High Compression garment Class II sleeve (prescribed) High CDT Combined decongestive therapy Gold standard Exercise Supervised progressive resistance Growing evidence Weight management BMI reduction target Beneficial Kinesio taping Adjunct to CDT Moderate Surgical (LYMPHA) Lymphovenous anastomosis Specialist centres only Antibiotics For cellulitis episodes (IV if severe) Essential FIG 04 Lymphoedema Surveillance and Treatment Pathway — 6 Steps Step 1 Axillary surgery or RT complete Step 2 Baseline limb volume measured Step 3 Surveillance (bioimpedance / circ.) Step 4 Early detection trigger identified Step 5 CDT referral (MLD + compression) Step 6 Long-term self- management + garment Baseline measurement before surgery ideal. Bioimpedance detects subclinical (Stage 0) lymphoedema before visible swelling. Lymphoedema never fully resolves — lifetime management required. Garment compliance key to long-term volume control. FIG 05 Clinical Presentations and Interventions Subclinical (Stage 0) Bioimpedance positive No visible swelling yet Mild pitting (Stage 1) Visible swelling Reversible with CDT Non-pitting (Stage 2) Fibrosis established Ongoing compression Cellulitis complication Erythema, warmth, fever IV antibiotics if severe Manual lymphatic drainage Specialist physiotherapy Core CDT component Compression sleeve Class II + gauntlet Lifelong use recommended CDT = combined decongestive therapy (MLD + compression bandaging + exercise + skincare). Gold standard first-line treatment. CDT can reduce limb volume by ~50–60%. Garment worn during waking hours; bandaging used during intensive phase. Surgical options (LYMPHA, vascularised lymph node transfer) available at specialist centres for refractory cases. Cellulitis: prompt antibiotic treatment essential — infection accelerates fibrosis and worsens staging. FIG 06 Key Statistics 15–25% risk after ALND [1] DiSipio et al. Lancet Oncol 2013 <5% risk after SLNB [2] Fleissig et al. Lancet 2006 Lifetime condition never fully resolves [3] Armer et al. J Lymphoedema 2020 ~50–60% volume reduction with CDT [4] Lasinski et al. PM&R 2012 FIG 07 References 1. DiSipio T et al. Incidence of unilateral arm lymphoedema after breast cancer. Lancet Oncol 2013;14:500. 2. Fleissig A et al. Postoperative arm morbidity and quality of life. Lancet 2006;367:1631. 3. Armer JM et al. BCRL burden and measurement. J Lymphoedema 2020. 4. Lasinski BB et al. A systematic review of the evidence for CDT. PM&R 2012;4:580. 5. NICE NG101. Early and locally advanced breast cancer. 2023. Clinically authored by Dr Fiona Tsang-Wright , FRCS (Gen Surg) GMC 4549831 · ORCID 0000-0003-4801-026X
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Definition
Lymphoedema is chronic swelling of an arm or other body part caused by impaired drainage of lymph fluid, most often after lymph nodes have been removed or damaged during cancer surgery or radiotherapy.

Common questions The questions patients ask first

Will I definitely get lymphoedema after axillary surgery?
No. Most patients do not develop lymphoedema. The risk depends on the type of operation, whether radiotherapy is given, and individual factors1. Around 1 in 5 patients having full axillary clearance, and around 1 in 10 to 1 in 20 having sentinel biopsy alone, develop some degree of lymphoedema over their lifetime — and most cases are mild15.
Can I exercise normally after breast cancer surgery?
Yes — and you should. Exercise is protective against lymphoedema, not a cause of it3. Specific guidance is given by physiotherapy after the operation, and most patients return to their usual activity (including weight training, swimming, racquet sports, golf) over the course of a few months.
What should I do if I notice swelling in my arm?
See your breast care nurse or specialist team promptly. Early assessment of new arm swelling — even if it turns out to be nothing — is the right approach. Lymphoedema picked up early responds well to compression and physiotherapy; later intervention is harder.
Is lymphoedema reversible?
Mild, recently developed lymphoedema can often be brought back to nearly normal size with compression and physiotherapy. Long-standing lymphoedema is more difficult to fully reverse but can usually be well managed and prevented from progressing.

Lymphoedema is chronic swelling of an arm or other body part caused by impaired drainage of lymph fluid, most often after lymph nodes have been removed or damaged during cancer surgery or radiotherapy.

After breast cancer surgery that involves the lymph nodes in the armpit, a proportion of patients develop lymphoedema in the arm on the operated side. The risk is much lower after sentinel lymph node biopsy than after axillary clearance. Most cases are mild and managed well with early intervention; severe lymphoedema is now uncommon in modern practice.

Orientation Why you might be reading about this

You may be deciding what kind of axillary surgery to have, recovering from breast cancer surgery and wondering what to watch for, or noticing some swelling and wondering whether to be concerned. This page explains what lymphoedema is, when it is most likely to develop, what to do at the first sign, and what treatment looks like.

Related terms: Sentinel lymph node biopsy · Mastectomy · Lumpectomy · Axillary clearance

Mechanism How lymphoedema develops

The lymphatic system is a network of vessels that carry lymph — a clear fluid containing immune cells — from tissues back to the bloodstream. Lymph from the arm and the breast drains through the axillary lymph nodes in the armpit. When some of those nodes are removed during surgery, or damaged by radiotherapy, the lymphatic drainage from the arm is reduced. The body usually adapts and finds alternative routes — most patients have no long-term problem — but in some patients the drainage cannot keep up with the inflow, and lymph fluid accumulates in the arm, causing swelling.

The swelling can develop weeks, months, or years after the original surgery. Early lymphoedema is reversible; later, longer-standing lymphoedema becomes harder to fully reverse, which is why early intervention matters.

Risk factors Risk factors and approximate rates

The main factors that determine the risk of lymphoedema after breast cancer surgery are the type of axillary surgery and whether radiotherapy is given to the axilla:

Operation Approximate lifetime lymphoedema risk
Sentinel lymph node biopsy alone ~5–8%1
Sentinel biopsy + axillary radiotherapy ~10–20%12
Axillary clearance ~20–25%1
Axillary clearance + radiotherapy up to ~30%12

Other factors that raise risk include obesity, repeated arm infections, and (less clearly) heavy upper-body work or specific physical activities — though current evidence shows that regular exercise reduces lymphoedema risk rather than increasing it3.

Early signs How to spot lymphoedema early

Early signs of lymphoedema are subtle. The arm on the operated side may:

  • Feel heavier or fuller than the other arm, particularly at the end of the day.
  • Have tighter-fitting rings, watches, or sleeves.
  • Look slightly larger in circumference when measured against the other arm.
  • Feel tight or stretched along the inner upper arm.
  • Have pitting when pressed gently — the indentation persists for a moment after the finger is removed.

Any of these, particularly when persistent over a few days, should prompt early review. Some specialist services also offer baseline and serial bioimpedance spectroscopy (BIS) measurements to detect early subclinical swelling, in line with updated NICE NG101 (2025). Specialist physiotherapy and lymphoedema services can intervene effectively at this stage.

Treatment Treatment

The management of lymphoedema is layered, with each step matched to severity:

Mild lymphoedema

  • Compression garments (sleeves) worn during the day4.
  • Skin care — moisturising, careful protection from cuts and infections4.
  • Regular gentle exercise — particularly arm exercises, swimming, walking. Exercise is part of the treatment, not a risk factor3.
  • Manual lymphatic drainage — a specific massage technique performed by a trained therapist4.

Most cases respond to this combination and do not progress4.

Moderate to severe lymphoedema

  • Multilayer bandaging for an intensive treatment phase, then transitioning to compression sleeves4.
  • Ongoing specialist physiotherapy.
  • Pneumatic compression pumps in some cases.
  • Surgical options at specialist centres — including lymphovenous anastomosis (microsurgical reconnection of lymph vessels to small veins) and vascularised lymph node transfer. These are reserved for selected patients with established lymphoedema that has not responded to conservative management.

Prevention Prevention — what helps

The single most useful preventative is early intervention if symptoms develop — lymphoedema picked up early responds much better to compression and physiotherapy than lymphoedema that has been present for months. Beyond that:

  • Regular exercise — strongly protective. Avoid the older advice to “rest the arm” — current evidence is the opposite.
  • Skin care — keep the skin intact, treat cuts and scratches promptly.
  • Avoid medical procedures on the operated arm where possible — blood pressure cuffs, blood draws, intravenous lines are usually best on the other arm. This is a soft preference rather than a strict rule, and is more important after axillary clearance than after sentinel biopsy.
  • Maintain a healthy weight — obesity increases lymphoedema risk and makes existing lymphoedema harder to manage.

Living with it Living with lymphoedema

Most patients with mild-to-moderate lymphoedema lead unrestricted lives, with sleeve management as part of daily routine. The condition does not affect life expectancy. The practical implications are usually around managing flare-ups, finding well-fitting compression garments, and protecting the arm from skin infections.

The breast care nurse team and the lymphoedema service can refer you to patient support networks with members who have been through the same path.

At consultation What to discuss with your surgeon

If lymphoedema risk is a factor in your treatment decision:

  • The lymphoedema risk specific to the axillary operation being proposed.
  • Whether axillary radiotherapy is an alternative that might give similar disease control with lower lymphoedema risk.
  • The local specialist lymphoedema service that would be involved if symptoms develop.
  • What signs to watch for and how to access prompt review.

If you are post-operative and concerned about possible early lymphoedema, the route is usually through your breast care nurse team or directly through the practice — early review is straightforward to arrange.

Resources Further reading

Sources & guidance

Every figure on this page is anchored to a published source. Tap a number in the text or below to jump to the reference.

  1. meta analysis DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. The Lancet Oncology. 2013 ;14(6):500–515 doi:10.1016/S1470-2045(13)70076-7 Cited for: Lymphoedema incidence by axillary surgery type and radiotherapy: ~5% after sentinel-node biopsy; ~20% after axillary clearance; risk amplified by axillary radiotherapy and obesity.
  2. rct Donker M, van Tienhoven G, Straver ME, et al. (AMAROS investigators). Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. The Lancet Oncology. 2014 ;15(12):1303–1310 doi:10.1016/S1470-2045(14)70460-7 Cited for: Axillary radiotherapy as an alternative to clearance after positive sentinel node — comparable disease control with significantly lower lymphoedema rate.
  3. rct Schmitz KH, Ahmed RL, Troxel A, et al. Weight lifting in women with breast-cancer-related lymphedema (PAL trial). New England Journal of Medicine. 2009 ;361(7):664–673 doi:10.1056/NEJMoa0810118 Cited for: Slowly progressive weight-lifting is safe and reduces lymphoedema flare-ups; supersedes earlier 'rest the arm' advice.
  4. guidance International Lymphoedema Framework / British Lymphology Society. Best Practice for the Management of Lymphoedema (2nd edition). London: ILF. 2012 https://www.lympho.org/best-practice-documents Cited for: Decongestive therapy components: compression garments, manual lymphatic drainage, multilayer bandaging, skin care, exercise; staged severity-matched management.
  5. guidance National Health Service (NHS). Lymphoedema. nhs.uk. 2024 https://www.nhs.uk/conditions/lymphoedema/ Cited for: UK NHS patient-facing overview of lymphoedema causes, prevention, and access to specialist services.