Swelling after Sentinel Lymph Node Removal

FFJohn

First, I would like to thank everyone here for the extensive amount of information and the inspiring support you all provide. 

I was diagnosed with invasive malignant melanoma on my left wrist in June 2014. I had surgery on July 3rd which included a wide local excision around the melanoma on my wrist and a SLB to remove lymph nodes near my elbow and under my arm. 

Since the surgery, the visible sutures seem to be healing very well with no signs of infection. Unfortunately, the swelling in 2 areas where the lymph nodes were removed has continued to increase every day & is becoming quite painful. My doctors office just recommended I continue using ice packs until my post-op checkup later this week. 

Although I have searched extensively online & found very useful information on this site, my swelling seems much more localized than everything I can find regarding Lymphedema. The swelling under my arm is approx the size of 1/2 tennis ball but there is no general swelling in the rest of my arm. I was hoping somebody might have some insight & advice. Thanks!

BrooksideVT

I had a similar swelling.  It was a seroma, fluid leaking around the surgical site.  I suppose it would have resorbed in time, but I was not about to wait.  Like you, I was afraid of lymphedema.  It was late afternoon on a weekend, so I went to the ER, who identified it, and got me in to see the surgeon the very next day.  He squeezed me right into that day's surgical schedule.  I guess to find an repair the "leak" was probably a 15-minute procedure. 

Fayette37

Rest easy...except for the beard and the chest hair, you and I have nearly identical reflections right now.  The swelling is almost definitely a seroma--which is a non-life-threatening pain-in-the-armpit bugger of a complication after lymph node dissection.

I had 17 lymph nodes removed two weeks ago, and have struggled with seroma(s) ever since.  It was aspirated once in my surgeon's office about 9 days ago.  The nurse swathed me in two Ace bandages to compress the area.  (This was VERY uncomfortable, as I've had nerve damage/pain in my chest post-mastectomy.)  After 48+ hours, it was growing back, so I stopped the compression so I could function.   It's now the size of an egg.  I'm about 4'11'', so this is pretty impressively sized for me!  I start chemo at the end of the week, so I hope it can be resolved before I start this next fun stage.

You'll be fine, John. : )  I would just call my surgeon/doctor in the morning and let them know what's going on.  They can drain it and, hopefully, it won't come back!  My understanding is that lymphedema would be a much more generalized swelling of the arm/hands, but the doc can reassure you.  

Binney4

FFJohn, welcome. Sorry for the problems that brought you here, but glad you found us. I'll second Brookside's suggestion that this could be a seroma. They can be drained if they're painful or limiting, as this is. Since the area involved is likely still numb from the surgery, draining is most often painless.

On the other hand, since it could also be lymphedema (and since at any rate you're at risk for lymphedema), the use of ice packs should be done with care. Extreme temperatures can trigger swelling which, with your compromised lymph system, can overload the lymph system and lead to lymphedema. Use an ice pack only with a layer or two of extra padding between it and your skin, and limit the time to no more than 15 minutes at a time.

Some strategies for reducing your risk of developing lymphedema here:

http://www.stepup-speakout.org/riskreduction_for_l...

Considering your risk, an evaluation by a well-trained lymphedema therapist would be a really helpful next step. S/he can assess your present needs, take baseline measurements for future reference, give you personalized suggestions for risk reduction, measure you for a compression sleeve and glove (or gauntlet, a fingerless glove) to use prophylactically for travel and strenuous activities, and teach you a gentle lymphatic massage that you can also use prophylactically. Here's how to find a well-qualified lymphedema therapist near you (any doctor on your team can write you a referral):

http://www.stepup-speakout.org/Finding_a_Qualified...

Please let us know what you discover.

Be well!
Binney

Binney4

Hello, Fayette! Sorry to hear you're dealing with a seroma. I did too, and I know it can be a really unwelcome added stress. Hoping this is quickly resolved and the next treatment phase is nothing but smooth sailing!

It's true that most of the time lymphedema presents as generalized swelling over a wide area--the upper arm, say, or the breast, or the hand. But it can also present in smaller, more limited areas, commonly around joints--elbow, thumb, axilla for instance. This can cause a delay in getting treatment, because doctors are frequently clueless where lymphedema is concerned. Another good reason to see a lymphedema therapist for an initial evaluation and baseline measurement. Go for it!

Be well,
Binney

glennie19

I had a seroma also. I think he pulled my drains too soon. The first time he drained it, he took out 140 ml!

Call your doctor on Monday, and get it to see him. And Binney has great advice about LE. I've learned a LOT from her.

Best of luck to you.

FFJohn

BrooksideVT,

Thank you! After seeing your reply, I looked up "seroma" and that seems to describe my swelling exactly. 

I contacted my surgeons office twice during the past week as the swelling & pain continued to increased. They advised me to continue the cold packs/elevation & go to the ER if it worsens over the weekend. I actually did go to the ER last night. ER Dr did not want to do anything without first talking to my surgeon. After paging him 3 times & waiting 4 hours without a response, the ER Dr sent me home with pain Rx & told me to use heating pad to "dissolve the fluid & help it be reabsorbed". Luckily, I had previously read on this site that heat would likely worsen the swelling so I am disregarding his advice. 

I plan to contact my surgeon (not just the nurse who I spoke to previously) first thing Monday morning to follow up. 

This has given me a whole new level of empathy for the difficulties faced by those who are battling breast cancer, especially since my condition is comparatively minor. 

FFJohn

Fayette37 - Thank you for the info & reassurance. Good luck with with your upcoming chemo!

Binney4 - Thank you for the advice & links. Unfortunately, I was blindly following the nurses instructions and as my swelling increased, I was increasing the amount of time that I kept the icepacks applied. I will reduce that time dramatically now. I have a lot of reading to do tonight but your links will save me many hours of research!

Glennie19 - Thanks for sharing your experience. You said that you had 140 ml the first time he drained it. Do you mind me asking how many time it needed to be drained?

I am also wondering if anyone can give me a rough idea of the time it takes to heal "completely". I understand that there may be some minor lingering issues and the risk for onset of lymphodema in the future. My concern is with being initially cleared to return to work. I'm a firefighter/paramedic and need a doctor's release with no physical limitations before I am allowed to return.

Thanks again!

beatrice00

It's a seroma that will go down slowly. Look up lymphatic drainage massage for the arm and torso and maybe do the motions very lightly. Do you have something that you can wrap around the area lightly? I have torso and arm LE and get occupational therapy and drainage massage weekly. You will be ok. 

glennie19

FFJohn, I had it drained 3 times. The first time was the most by far. I can't remember the second one,, maybe around 40?  and then the last one was less than 20.

The nurse also put a compression bandage on me after the fluid was drained so that my body would help to reabsorb the fluid. 

glennie19

I just reread your post. I missed the part about you being a firefighter/paramedic. ((hugs))

How long until you can go back to work is really hard to say.  But since your work is very physicial, and you do run the risk of lymphedema, you may want to get fitted for a sleeve/gauntlet before going back to work and wear it when you are working and doing physical activity.  A visit to a certified LE therapist would be a good thing for further advice.

And I hope all your nodes were negative!

Binney4

John, being fit before the surgery gives you some protection as you make your return to work. But if you want to avoid problems it really will be important to start back to full physical activity slowly and watchfully. Here are guidelines for fitness instructors helping cancer veterans back to full activity:

http://www.stepup-speakout.org/Trainer%20doc%20for...

And here are the exercise guidelines for patients themselves, What You Should Know for a Smart, Safe Workout:

http://www.stepup-speakout.org/Handout%20doc%20for...

Thanks for the work you do. Even if we don't live in your community, what you do affects us all. (In fact, for those of us with bilateral lymphedema it's often the paramedics at our local firehouse who can do a leg blood pressure correctly without our having to teach them how--nurses, not so much!)

Be well,
Binney

FFJohn

First I would like to thank everyone again for the information & support. My situation is likely the most minor health issue on this entire website yet complete strangers have taken the time to share their valuable advice & experience. I am truly grateful. I also have good news to share. The pathology tests found clear margins on the skin that was removed and found no signs of cancer in the lymph nodes that were removed! I still need to return to my dermatologist for a full examination & "body mapping". There may be a few other spots that she may want to remove & test. 

As advised, I contacted my doctor to have him check the swelling in the 2 areas where he removed lymph nodes. He confirmed they appeared to be seromas. 

The smaller of the 2 is on the inside of my arm, just above the elbow. He was able to drain a yellowish fluid using a needle & syringe. He was hopeful that the swelling would not return or would return slowly & to a lesser extent. Unfortunately, a few hours later it appears to be the same size as before it was drained. 

The larger, baseball sized swelling under my arm would not drain despite several attempts, each from a different side, along with extensive digging. He said this meant the swelling was likely a hematoma and that the blood has coagulated which made it too thick to be aspirated through the needle. I asked what I should do next. He said that I would just have to wait for it to gradually the absorb on its own which might take 2-8 weeks, but if it continues to worsen it might require surgical intervention. 

As suggested, I will be be making phone calls tomorrow to schedule an evaluation with a lymphedema specialist in my area. 

Thanks again! - John

glennie19

YAY for clean margins and negative nodes!!!  So happy to hear that.

Bummer about the swelling, but I hope it will resolve on its own w/o any problems.

glennie

Binney4

Hey, hey on the path report! Whew, great news! 

As for the larger swelling under the arm, lymphedema also cannot be drained with a syringe (because the fluid is dispersed among the cells, not pooled as in a seroma. Just something to keep at the back of your mind. Also, when lymphedema is present the risk of infection is high (because of  the warm, protein-rich lymph fluid stagnating there--perfect medium for bacterial growth). So do watch carefully after all that "digging" (ouch!) for any sign of infection--new redness, new swelling, fever, warmth to the touch, flu-like feelings, pain, itching. If you suspect infection get help immediately--even at night or over the weekend--as a cellulitis infection is an emergency (well, shoot, you probably already know that…).

http://www.stepup-speakout.org/Emergencies_and_Med...

Hoping you'll see nothing but steady improvement over the next couple of weeks! And do let us know how it goes with the therapy appointment.

Be well,
Binney

BrooksideVT

Oh yeah, I wrote that my lump was a seroma; it was a hematoma. I guess that was why they repaired it surgically.  Do not be surprised, by the way, when your whole chest turns bright purple as gravity does its thing.

fizzdon52

Hi John, trust your instincts. I had a seroma and my Breast Care Team didn't seem too concerned either, saying it would just re-absorb. It burst one Saturday night and because no-one in the Medical profession seemed concerned I just dressed it myself etc. I ended up with Cellulitis and was hospitalised on an IV drip. So I would be careful with it. Good luck to you from Donna in New Zealand