Swelling, discomfort and skin thickening in the arms and legs may be related to a condition known as lymphedema. John R. Barbour, MD, FACS, is a triple board-certified plastic and reconstructive surgeon who offers lymphedema treatment for the residents of the Washington, DC, area, including Fairfax, Arlington, Alexandria and surrounding communities in Virginia.
Lymphedema is a collection of protein-rich lymphatic fluid, usually in the arm or leg. It is caused by interruption of normal lymphatic flow often due to surgery, radiation, infection or trauma. It is the protein in the fluid that makes it difficult to treat. The protein acts as a magnet for more swelling and serves as a food source for infections. With normal lymphatic flow, the amount of fluid going into the arm or leg is equal to the fluid that is going out. In lymphedema, the amount of fluid going in is greater than the amount that can go out because of the damage to the “transport system.”
Lymphedema occurs most commonly in women who have had breast surgery with removal of lymph nodes, followed by radiation therapy. It can appear weeks, months or even years after the initial surgery. It may also occur following injury or infection. In each case, normal drainage of the lymphatic fluid is interrupted.
Lymphedema can often be managed with therapy and self-care. However, for many patients, surgery may help reduce the severity and symptoms of lymphedema. Surgical procedures involve bypassing the lymphatic system to drain off excess fluid and relieve swelling. Whether or not lymphedema surgery is covered depends on your insurance company.
Very few surgeons are qualified to offer these procedures, and you will need to investigate the experience of any surgeon you are considering. You can ask how many times he or she has performed surgery for breast cancer-related lymphedema and also ask to speak with some former patients. Although surgery may help reduce the volume of the arm, it will be essential to maintain those results with other treatments, such as continuous compress garment usage. Common treatments for lymphedema are below:
