Patients who have been treated at SCCA can be seen in the physical therapy department by one of our Certified Lymphedema Specialists, who are trained in teaching patients how to manage lymphedema. While there is no cure for lymphedema, patients can be taught self-care techniques that can avoid the most severe complications of lymphedema. Located on the fourth floor of the SCCA outpatient clinic on Lake Union, Physical Therapy is open Monday through Friday, 8 am to 5 pm and can be reached by phone at (206) 606-6373.
In addition, our therapists can prescribe compression garments to manage the buildup of fluid in the arms, legs, and other parts of the body affected by lymphedema. Compression garments for legs, arms, breast and trunk are available at Shine, a specialty gift and oncology service store located at SCCA House in South Lake Union. The staff at Shine are trained in fitting compression garments for patients and providing advice.
And for some patients, surgery at the University of Washington may be appropriate to help alleviate the most severe symptoms of lymphedema.
Complete decongestive therapy
SCCA’s physical therapists may recommend Complete Decongestive Therapy (CDT) to treat lymphedema. CDT is a non-invasive approach to treating lymphedema. CDT typically has two phases— the first phase happens at SCCA with our physical therapists who teach patients how to treat themselves. In the second phase, the patient themselves take the techniques they’ve learned to manage swelling on their own.
CDT includes compression, lymphatic massage, lymphatic exercises and skin care. Compression helps to decrease swelling and prevents it from getting worse. Lymphatic massage is a type of light self-massage that’s intended to get the lymphatic vessels to pump faster. Massage also helps to reroute the fluid to a lymphatic pathway that’s not blocked or damaged. In addition, patients are counselled on the importance of skin care and avoiding and managing situations that can cause swelling and overload the lymphatic system, for example, insect bites, cuts and burns in the arms and legs. Specific lymphatic exercises which cause the contraction of muscles can also help the movement of lymphatic fluid as well.
Surgery for Lymphedema
For patients who have undergone CDT and continue to have difficulty managing lymphedema, surgery at the University of Washington may be an option. Until recently there have not been any good surgical options for treating lymphedema. However, in recent years several new procedures have been developed. These procedures don’t cure the lymphedema, but they may provide relief from swelling and discomfort and they generally make the lymphedema easier to manage.
Plastic surgeons at University of Washington Medical Center can perform the following procedures for patients who develop lymphedema after breast cancer treatment: lymphaticovenular anastomosis and lymph-node transfer.
Lymphaticovenular anastomosis (LVA) involves making several small skin incisions in the affected arm. Just under the skin, the lymphatic channels can be found. The surgeon joins several of these channels to nearby veins so lymph can empty into the venous system, without having to go through the axilla. LVA is performed under an operating microscope and requires a high level of skill. It takes about four hours. Because the incisions are not deep, there is very little post-operative pain and the patient can go home the same day.
Lymph-node transfer for breast cancer patients involves removing lymph nodes from elsewhere in the body (the groin or the neck) and transferring them to the axilla. These lymph nodes are transferred with the blood vessels that nourish them, and these blood vessels are attached to blood vessels in the axilla. After the procedure, the transferred lymph nodes start to drain lymph from the affected arm. Lymph node transfer is a more complex procedure than LVA. It involves a four-to-five hour operation and a three-to-five day hospital stay. Recovery is fairly rapid, and patients can expect to be back to normal in three to four weeks. With this procedure and with LVA, the reduction in swelling is gradual; it takes place over a period of about one year after the surgery.
Your care team can help you determine whether surgery is an appropriate option for you.
Reviewed June 2016