Stage I, II, IIIA, and operable IIIC breast cancer often requires a multimodality approach to treatment. Irrespective of the eventual procedure selected, the diagnostic biopsy and surgical procedure that will be used as primary treatment should be performed as two separate procedures. In many cases, the diagnosis of breast carcinoma is made by core needle biopsy. After the presence of a malignancy is confirmed, treatment options should be discussed...
Ideally, prevention should begin before treatment, by educating the patient and family in a sensitive fashion about the potential risk of developing lymphedema. Proceeding in this way may diminish a breast cancer survivor's dissatisfaction with the educational information received about lymphedema, and could serve as a foundation for making decisions and coping with lymphedema, should it develop later. Patients should be taught to recognize the early signs of edema because treatment outcomes may be significantly improved if the problem is detected early.
Wear gardening and cooking gloves and use thimbles for sewing.
Avoid going barefoot outdoors.
Avoid blood draws (including finger sticks), vaccinations, or intravenous lines in the affected arm.
Use the unaffected extremity to test temperatures (e.g., for bath water or cooking), as sensation may be diminished.
Be aware of the signs of infection (fever, swelling, redness, pain, and heat) and see a physician for evaluation immediately.
Keep the arm or leg elevated above the level of the heart when possible.
Avoid constrictive pressure on the affected arm or leg.
Do not cross legs while sitting.
Wear loose jewelry and clothes with no constricting bands.
Carry a handbag on the opposite arm.
Do not use elastic bandages and stockings with constrictive bands.
Do not sit in one position for longer than 30 minutes.
Avoiding the Pooling of Blood in the Involved Extremity
Avoid rapid circular movements that cause centrifugal pooling of fluid in distal parts of the limb.
Avoid local application of heat to the limb, which may increase blood flow.
Do not maintain the limb in a gravity-dependent position for long periods of time.
Avoid tight-fitting clothing or blood pressure monitoring in the affected arm, which could cause a tourniquet effect and obstruct lymph flow.
The goal of lymphedema treatment centers on controlling limb swelling and minimizing complications; the underlying lymphatic vessel interruption cannot be corrected. Because clinical trials evaluating pharmacologic measures are generally not found to be effective, nonpharmacologic measures are the mainstay of treatment, with the goal of maximizing the activities of daily living, decreasing pain, increasing range of motion, and improving function.