Lymphedema develops when a fluid, called lymph, gets trapped in soft tissues.
Lymph is an important bodily fluid containing proteins and fats that circulates infection-fighting white blood cells as part of the lymphatic system — a lesser-known network of vessels that co-exists with arteries and veins. If lymph can’t move properly throughout your body, your risk for infection rises, and you may eventually develop heavy deposits of fat and scar tissue in the affected area of the body that can make it more difficult to move.
The first signs of lymphedema include swelling or a feeling of fullness in an arm or leg. Early intervention is paramount, as treatment options are less effective the longer the condition exists.
What you need to know about Lymphedema
1. Different things can cause lymphedema
You can have a genetic predisposition for lymphedema, or it can develop after physical trauma or illnesses, like cancer. In the United States, lymphedema’s most common cause is cancer treatment.
Lymphedema is particularly common in those who have had treatment for breast cancer, which commonly involves radiation and/or removal of the lymph nodes. (Lymph nodes filter out bacteria, viruses and other foreign substances and are the part of the lymphatic system.) Any time cancer treatment involves the removal of lymph nodes, this condition can occur.
2. Lymphedema usually gets worse over time
There are four stages of lymphedema. In the earlier stages of lymphedema, you won’t be able to see any changes to your skin yet but might notice mild tingling or a heaviness in your arm or leg. In later stages, the affected area can swell so much that it doesn’t fit into shoes or shirts you wear regularly and may limit your movement. If your provider is able to identify lymphedema early on, you’ll have the greatest chance of preventing the progression of your disease as well as permanent damage.
3. Lymphedema can be treated in a variety of ways
Compression therapy is a common treatment for early stages of lymphedema. This involves bandages and/or garments that apply controlled pressure to the affected part of your body and help to push the lymph out of the affected area. Certified lymphedema therapists often pair compression therapy with a specific type of massage, called manual lymphatic drainage, as well as stretching, exercise and pumping the lymph out of the soft tissues.
Before the last 10 years or so, lymphedema treatment didn’t often go beyond these techniques. Now, though, advances in technology have led to more options, in addition to tested standbys like compression therapy and massage.
In recent years, occupational therapy offers treatments a number of treatments to help help reduce tissue fibrosis and lymphedema girth. Some examples are photobiomodulation, a form of light therapy that can improve pain and wound healing, and negative pressure devices similar to cupping that can reduce swelling.
Innovative surgeries are also now possible thanks to powerful microscopes and extremely fine sutures. These new techniques and technologies allow for much better surgical outcomes for patients.
4. Three types of lymphedema surgery are available
One is called lymphovenous bypass, and it’s most useful when parts of the lymphatic system still work. During the procedure, surgeons connect those portions of the lymph channels that are still functioning to nearby veins. That way, your body can literally bypass the part that’s blocked and use the vein to return lymph back to the circulation.
Lymphovenous bypass is also aless invasive operation and patients generally get to go home the same day, although they’ll continue with compression therapy for at least a month afterward.
The second kind of surgery is called vascularized lymph node transplant or sometimes, vascularized lymph node transfer. This involves harvesting tissue that contains lymph nodes and lymphatic tissue from somewhere else in your body, typically in either the neck, groin, or abdomen and transferring that tissue to the area with lymphedema. That way, the functioning lymph nodes can augment lymphatic return in the affected area.
A vascularized lymph node transfer tends to require several days in the hospital to recover and is most successful in earlier stages of lymphedema.
For later stages, the best surgical option is often removal of skin and/or fat from the area where the lymph has built up. This can be done through liposuction and/or direct removal of the excess soft tissues. This operation reduces the weight of the leg or arm and makes it easier for people to move.
One of the biggest limitations of lymphedema surgery is that no one can yet predict if a patient will respond positively to either operation. In many cases, the doctor may try more than one solution to insure the best outcome.
5. Insurance coverage for lymphedema surgery has expanded
As noted above, the fact that lymphedema surgery doesn't always solve the problem, insurance companies haven't been willing to pay for it. Recently, Blue Cross Blue Shield of Michigan, the state’s largest health insurance carrier, has agreed to change their policy when it comes to lymphedema surgery. Starting in 2021, Blue Cross Blue Shield now recognizes lymphedema surgery as legitimate as long as it’s offered for patients who are good candidates for it and performed by reputable surgeons who are trained in lymphedema surgery.
6. Educational resources are available for both patients and providers about lymphedema
Michigan Medicine was recently designated as a comprehensive center of excellence by the Lymphatic Education & Research Network in recognition of its ability to provide advanced treatment for lymphedema. The health center joins just 12 other institutions worldwide with this certification and plans on harnessing the resources available from LE&RN to learn from other institutions and educate both its patients and its providers about lymphedema.