Post-radiation swelling/hardness

Maerimac

I finished radiation eight weeks ago. I had some swelling during and after the radiation, but suddenly in the last few days my breast has ballooned. I had sixteen radiation treatments to the entire breast, and five "boosters" to the incision/tumour site. Following that, I felt like I had a very firm "band" across the incision but had heard that thickening of tissue was not unusual. Now with the new swelling, it seems that the hard area is much larger and also very tender. Has anybody experienced this post-rads. I am also on tamoxifen (six weeks in now), but am assuming this is related to the rads. Thanks for any info/suggestions.

kira66715

It is normal to get some swelling with radiation, but there is also breast lymphedema, which has become much more common in the era of sentinel node biopsy: it's treated with massage and gentle compression. I work in radiation oncology, and see it a fair amount of the time--quite often it does get better.

From bc.org

http://www.breastcancer.org/tips/lymphedema/ask_expert/2008_04/question_07.jsp

Breast lymphedema possible?

Page last modified on: August 25, 2008

Question from Amy: Does lymphedema only occur in the arm or can it be in the breast as well?

Answers -Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : Absolutely! Not only can it be in the breast as well, it can be exclusively in the breast and chest wall, even if it does not appear in the arm. So we need to recognize that breast edema and chest wall edema exist and should be treated.

Jennifer Sabol, M.D., F.A.C.S.: As a surgeon, I probably see it more acutely than most and have a more difficult time getting other physicians to acknowledge that there is such an entity as lymphedema of the breast which is actually quite uncomfortable for some patients as well as alarming, because it is difficult to ask for treatment for swollen breasts. I think maybe you can comment on how you manage patients like this.

Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : I would say, first of all, recognition is part of the key. I believe anecdotally that I am seeing more frequency of breast and chest wall swelling - lymphedema, if you will - now with the sentinel node biopsy, as we are removing the direct drainage pathway out of the breast. Unfortunately, it is going far underrecognized. Treatment for breast and chest wall lymphedema is analogous to the way we would treat the arm, meaning that the patients would require lymphatic drainage, compression, therapy, exercise, and skin care. Many of these patients will require custom fit or near-custom compression bras.

Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M.: I would say this is an international problem. I was at the Australasian Lymphology Association meeting in Perth in March, and this issue of seeing more breast edema was a theme there. It seems to me that the compression garments and treatments available are not as advanced as they are for arm edema, the compression garments in particular

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Nicole Gergich, M.P.T., C.L.T.-L.A.N.A. : I would agree with that to an extent. I think there are excellent compression bras that exist. I agree with you that we are as not highly evolved in this area in recognition, treatment, and management as we are with the arms.

Jennifer Sabol, M.D., F.A.C.S.: I would add one note of hope, and it is sort of anecdotal. I think this is one of the few times that lymphedema does have a tendency to regress. It's probably due to the acute injury of the radiation therapy. Breast edema does tend to go down over time, though it may not disappear. It is a very slow resolution of the edema and it's almost never complete. I generally tell patients to expect a very slow, ongoing improvement, even over 2 to 3 years after their radiation therapy, until they reach a stable plateau. I'd be curious if you two have found the same sort of better overall prognosis for the breast edema.

On Wednesday, April 16, 2008, our Ask-the-Expert Online Conference was called Preventing and Treating Arm Lymphedema. Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M.,Nicole Stout Gergich, M.P.T. C.L.T.-L.A.N.A., and moderator Jennifer Sabol, M.D., F.A.S.C. answered your questions about ways to prevent and manage lymphedema.

Here's a link to the stepup site on breast lymphedema

http://www.stepup-speakout.org/breast_chest_trunckal_lymphedema.htm

Watch the tenderness, if there's any redness or fever, it could be infection--other wise, it's likely just fluid/lymphedema, and can be treated. If you want a formal lymphedema therapy consult--the best bet--you'll need a referral from one of your doctors.

http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

When I see breast lymphedema, the skin is obviously thickened--gentle pressure shows all the pores, vs. the other side where they're not visible.

It does get better--especially with treatment.

Hope this helps.

Kira

Maerimac

Thanks Kira. I was wondering about that, but didn't want to be pushing panic buttons or taking up the docs time that somebody else may need more. I think I will check in with them tomorrow and see what they have available if that is the case. The strangest part is how quickly it's suddenly swollen - feels like the skin can't stretch anymore - very uncomfortable. Thanks again for your prompt response! Mary 

kira66715

Mary, it sounds very, very uncomfortable. Worth having your doctors check it out.

Kira

IllinoisNancy

Hi,

I finished radiation in Feb 07 and my breast has remained very firm and the nipple is always tender.  I just came from a doctor appointment and was informed that it will never go back to normal and that the scar tissue is what causes the firmness and tenderness in the nipple.  Oh joy.....good luck with your treatments.

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