Upper limb lymphedema is a common postoperative complication of breast cancer. It is caused by tissue destruction and/or fibrosis caused by surgery, radiotherapy and trauma, resulting in local soft tissue adhesions and reduction, compression and narrowing of small blood vessels and lymphatic vessels, resulting in impaired blood and lymphatic fluid reflux, resulting in increased interstitial protein concentration, reduced plasma colloid osmotic pressure difference, increased fluid leaving capillaries, and eventually edema.
In addition to being directly related to the surgical approach, the occurrence of upper extremity lymphedema can be caused or aggravated by a variety of postoperative factors.
Clinically, we have observed that the specific causes that directly lead to or induce lymphedema of the upper extremities are diverse and different, but in summary, they are mainly the following.
1. radiotherapy: If patients with axillary debridement receive postoperative radiotherapy, their chances of developing edema are significantly higher. The literature reports that the incidence of upper limb edema can increase from 9% to 26% when radiotherapy is added after radical surgery or modified radical surgery. This may be related to the large amount of radiation leading to occlusion and injury of blood vessels and lymphatic vessels in the radiation field, and radiotherapy can also lead to local muscle fibrosis, compressing veins and lymphatic vessels, affecting lymphatic reflux in the upper limbs, thus aggravating or causing upper limb lymphedema.
2.Infection: If the postoperative wound healing is poor or improper care causes infection, it will further damage the lymphatic vessels, and at the same time will prevent the reconstruction of lymphatic vessels and the establishment of collateral circulation, thus aggravating or causing upper limb lymphedema.
3. Trauma: If the affected upper limb is traumatized after surgery, it can cause the release of chemical substances such as histamine and inflammatory factors from local tissues, which can affect vascular permeability and further affect microcirculation, thus aggravating or causing upper limb lymphedema. In addition, trauma may also lead to infection.
4.Stimulation of chemical agents: If the skin of the affected upper limb is directly exposed to various chemical agents after surgery, it may damage the skin or penetrate into the skin, which may cause the release of corresponding chemical substances from the body tissues or even damage the blood vessels and lymphatic vessels, thus aggravating or causing lymphedema of the upper limb.
5.Exertion and weight-bearing: After a lot of exercise or weight-bearing of the affected upper limb after surgery, the blood circulation through the upper limb will increase and the corresponding lymphatic generation will also increase, thus aggravating or causing lymphedema of the upper limb.
6.Age: With age, the lymphatic vascular-venous short circuit gradually decreases, and at the same time, due to the relatively slow metabolism, the function of lymphatic reconstruction is also relatively poor, and the compensatory capacity of the whole lymphatic drainage decreases, which increases the chance of edema after surgery.
7, obesity: research shows that the chance of postoperative edema is higher in obese patients than in non-obese patients, and the higher the BMI the more serious the edema is. This may be more likely to occur with obese fat necrosis, prone to poor wound healing and infection.
8, hypertension: elevated blood pressure can increase the total amount of intravascular substances such as water and protein that penetrate outward and increase the amount of lymphatic production, thus aggravating or causing lymphedema of the upper limbs.
From the above triggering factors of postoperative lymphedema, we can see that some of them are side effects of treatment, which are not easy to prevent and control, but some of them are caused by mistakes in daily life, in which we can prevent or improve through efforts.
In order to minimize the risk of lymphedema after breast cancer surgery, based on the guidelines for reducing the risk of lymphedema proposed by the National Lymphedema Network (NLN) in 2001 and our own clinical experience, we would like to remind postoperative patients to pay more attention to the following aspects.
1. Pay attention to the detection of swelling of the affected limb;
2. The affected limb should not be held under weight or strained;
3.Protect the affected limb from insect bites and avoid blood collection and blood pressure measurement;
4. Do not touch the affected limb with any detergent, wear gloves when washing clothes or dishes;
5, pay attention to skin cleanliness and hygiene, after bathing can be rubbed oil skin care products, so that the skin to keep moist, to prevent the invasion of bacteria skin cracks and breaks;
6, pay attention to the affected side of the finger care, nails should not be cut too short, so as not to damage the keratin layer; “barbs” should not be tugged, should be carefully cut off with scissors;
7, do not wear tight necklaces and elastic bracelets and other jewelry for the affected limb;
8, the affected limb should not be hot or cold compresses, steam sauna, hot springs, etc.;
9, the affected limb should not do the same action for a long time or repeatedly, such as mopping the floor, cutting vegetables, writing, keyboard, etc.;
10, the affected limb should not do strenuous exercise or hand shaking, but some slow and gentle exercises, such as taijiquan, Badaanjin, etc;
11.When the limb feels pain, rest;
12, avoid strong sunlight;
13, winter to pay attention to keep warm;
14.Elevate the affected limb frequently to reduce edema;
15.If edema has been applied to the elastic sleeve or elastic bandage bandage, prolonged walking or air travel should be especially careful;
16.Low salt and low fat diet is recommended, and limit the intake of water and sodium;
17, eat more fresh vegetables and fruits, can eat rich in protein, vitamins, high heat, easy to digest food, avoid spicy and irritating food;
18.Strengthen the massage care of the affected limb, using centripetal massage of the affected limb, the technique should be moderate;
19, the affected limb function exercise should be early, and gradual, persistent;
20.If the skin of the affected limb breaks down or suddenly appears red, swollen, painful and other signs of infection, you should seek medical attention as soon as possible, and actively anti-inflammatory and anti-infective treatment;
21. Pay attention to the control of weight and blood pressure.
With the advancement of technology, the chance of lymphedema after breast cancer surgery will also be reduced. However, since breast cancer patients have a longer survival time, they have a greater chance to be exposed to various pathogenic factors. We only need to pay more attention in our daily life to minimize the chance of lymphedema so that it will not affect the quality of life after surgery.