What is the cause of axillary edema after breast cancer surgery

Lymphedema refers to tissue edema caused by the accumulation of lymph in the superficial soft tissue of the limbs due to congenital lymphatic dysplasia or secondary lymphatic reflux disorder. If lymphedema is found, active conservative treatment and protection are required. Early treatment can slow down the development of lymphedema. Actively carrying out sentinel lymph node biopsy and targeted axillary lymph node dissection are the most effective ways to prevent postoperative lymphedema.

Pathogenesis of postoperative lymphedema

The incidence of lymphedema after breast cancer surgery is 10 to 60 percent. Breast cancer lymph node dissection of the axillary or even subclavian lymph nodes blocks the main lymphatic circuit of the upper limbs, causing damage to the main lymphatic circuit of the upper limbs; poor drainage after surgery causes subcutaneous effusion in the axillary, wound infection, and wound edge necrosis, resulting in inflammation or scar hyperplasia, affecting postoperative lymphatic regeneration and return compensation. Radiotherapy is a common cause of inducing or aggravating lymphedema. The combination of surgery and radiotherapy, the large and deep scar nodules formed in the axillary and supraclavicular areas block the compensatory lymphatic circuit. Radiotherapy not only causes lymphedema, but also causes venous stenosis or occlusion, and the incidence of limb lymphedema increases significantly.

How can breast cancer patients protect themselves?

Patients should pay attention to observe whether there is slight edema in the upper limbs or chest. If it worsens, they should tell the doctor in time, often raise the affected limb, avoid prolonged drooping, and massage moderately; avoid blood drawing and injection of the affected limb; avoid measuring blood pressure in the affected limb. If bilateral upper limb lymphedema occurs, blood pressure can be measured in the lower limb; keep the skin of the affected limb, especially the wrinkles and finger gaps, clean and dry, and apply lotion after bathing; avoid doing strenuous and repetitive exercises that increase the resistance of the affected limb; do not lift heavy objects (5kg), carry a bag on the healthy side; do not wear tight necklaces and elastic bracelets; avoid high temperatures when showering or washing dishes, avoid saunas or hot baths, and use protective sun-drying products; avoid injuries to the affected limb, such as cuts, burns, sports injuries, insect bites, scratches, etc., and avoid any injuries when trimming nails; maintain an ideal body weight, eat a low-salt, high-protein, easily digestible diet, avoid smoking and drinking; wear gloves when doing housework or planting flowers; avoid excessive fatigue of the affected limb, rest when the limb feels pain, and raise the limb; it is recommended to do some exercise, such as walking, swimming, aerobic fitness, cycling and doing aerobics; any symptoms of infection, such as rash, itching, redness, pain, increased skin temperature or fever, should be reported in time; attach great importance to the infection of the affected limb and give the most active treatment.

Assistive treatment tools

1. Principle of physical-driven therapy device: The lymph fluid in the soft tissue is squeezed into the deep venous system through the mechanical action of periodic compression and decompression.

Advantages: quick effect, easy to use, adjustable pressure, can be used repeatedly. Disadvantages: high cost, easy to relapse if not used consistently, inconvenient to carry.

Contraindications for the use of physical drive therapy devices: Acute deep vein thrombosis, severe congestive heart failure, recent skin grafts, gangrene, erysipelas, internal artificial joints, prostheses

2. Principle of elastic sleeve: The highest support pressure is established at the wrist of the wearer, and the pressure gradually decreases upward along the arm, thereby reducing the congestion of local tissues, avoiding the accumulation of body fluids in a certain part of the arm, and improving local microcirculation. At the same time, the cuff acts as a support for the affected limb, which can help the muscles pump away body fluids and promote the return of lymph fluid in the damaged limb, achieving the therapeutic effect of reducing swelling.

Precautions for using elastic sleeves: The best time to wear the cuff is when you get up in the morning, and the best time to take it off is before going to bed at night (no more than 12 hours a day); after putting on the cuff, smooth it against your body; pay special attention not to let rings, bracelets or nails scratch the cuff when putting it on or taking it off; trim your fingernails frequently, and prevent chapped skin on your hands and arms in dry seasons to avoid scratching the cuff; use a neutral detergent to hand wash in warm water, do not wring it dry, squeeze it dry with your hands or use a dry towel to absorb excess water, and dry it in a cool place, do not dry it in the sun or bake it under artificial heat sources.

Advantages: easy to use, easy to carry, and relatively cheap.

Disadvantages: The pressure value is fixed and needs to be checked by a doctor every 4 to 6 months. The pressure value is relatively small (23-32 mmHg), which is more suitable for patients with weak constitution, postoperative patients or patients in the early stage of edema.

Surgery

Moderate lymphedema occurs when the circumference difference between the affected and healthy upper limbs is greater than 3 cm. Surgery is required when the hand begins to swell, radionuclide lymphoscintigraphy shows obvious obstruction of lymphatic return, and the affected limb is repeatedly infected. Surgery can reconstruct lymphatic return through microsurgical techniques, and can also achieve the effects of reducing volume, weight, and lymphogenesis through surgical treatment of local lesions.