Is breast swelling always lymphedema?

cgesq--it sure does sound like breast/truncal LE, which often presents as redness.

There was a study done at Mayo Clinic about the prevelance of breast LE with lumpectomy/radiation, and redness--especially in the "dependent" portions was common and so was edema. It tended to get better with time.

Often, women are treated again and again for a cellulitis, but it's "just" LE.

Whenever the quadrant is disrupted by surgery, you are at risk for LE. I've seen it alot in reconstructed breasts as lymph doesn't flow through scars.

Here is a link to the page on SUSO, and there is a medical artice at the bottom that is very useful:

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

It sure sounds like breast/truncal LE is a real possibility here, and you'll feel so much better if you're evaluated by a qualified therapist and if it is, you get the proper treatment.

A qualified LE therapist has taken a full 135 training, don't worry about LANA certification--it shows dedication but isn't absolutely necessary to get a good therapist:

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

And a word of warning: I took the full 135 course last summer and the focus was on arms and legs, breast and truncal LE were barely mentioned, so anyone you go see, be sure to talk to them about their comfort with truncal/breast LE. We've had qualified therapists tell women on this board that LE is only in the limbs (WRONG!!!)

And, just for reference, the topic was discussed at an ask the expert on bc.org:

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

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

Answers - Nicole Stout 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 Stout 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 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.Nicole Stout 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.

Let us know how you're doing.

Kira

There is such a thing as breast LE. You should be healed after 6 months

HUGZ

What ???!!!  I have to ask!

I had edema in both breasts the entire healing period after my bmx and diep.  After 7 months both breasts got red and infected.  PS was convinced it was LE and treated it as such.  After infection was gone edema still remained and redness at bottom of both breasts never went away.  11 months after original bmx I had reconstruction stage 2b with a new PS who said scar tissue had formed envelopes of fluid that never drained no matter how much massaging I did.  Since surgery 6 weeks ago to rid the scar tissue, both breasts are soft and normal looking.  You might want to consider scar tissue preventing proper drainage.

Purple, I didn't mean breast LE healed in six months. If we were all healed in 6 months these threads would be dead. Oh how I wish! I meant bmx surgery site, even me a slow healer, healed pretty fast. I'm sorry for my bad sentence structure.



I liked your drive you had in steering the PAL, YMCA exercise thingy. Good job!

Gotcha hugz ... I was confused for a minute there .

THX!

cgseq

Treating BOTH sounds like the best bet.  In the meantime, pls look at the SUSO page and  watch all precautions to take for LE.  You may well be at risk and able to avoid it.

Please let us know how you make out.

We care !

Personally, I think it's LE

Here is the abstract from Mayo, and they--in the body of the article--demonstrate that inferior breast redness (erythema) is very common with breast LE

I had found a quote from Hopkins that they won't do lat dorsi or TRAM flaps anymore.....

http://www.ncbi.nlm.nih.gov/pubmed/22415476

Breast Cancer Res Treat. 2012 Aug;134(3):915-22. doi: 10.1007/s10549-012-2004-x. Epub 2012 Mar 14.

A prospective study of breast lymphedema: frequency, symptoms, and quality of life.

Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.

Source

Department of Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA. degnim.amy@mayo.edu

Abstract

Although lymphedema of the arm is a well-known complication of breast and axillary surgery, breast lymphedema has received scant attention. We sought to prospectively characterize breast lymphedema's incidence, associated symptoms, clinical course, and impact on quality of life. Subjects were enrolled prospectively from a consecutive sample of patients undergoing non-mastectomy breast procedures (excisional biopsy or wide local excision ± lymph node removal) and followed for signs and symptoms of lymphedema in the operated breast. Symptoms and distress were serially assessed with 11-point linear analog scales. Breast lymphedema was diagnosed independent of symptoms, based on the distribution and degree of edema and erythema. One hundred twenty-four women were followed for a median of 11 months, and breast lymphedema was diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast surgery with axillary node removal (49%) compared to breast surgery alone (0%), p < 0.0001. Breast lymphedema involved multiple quadrants in most women and was characterized by edema in 100% and erythema in 79%. Patients with breast lymphedema were significantly more likely than women without breast lymphedema to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness (62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but symptom-associated distress was low overall. Three of 32 breast lymphedema patients with clinical follow-up developed chronic edema. Breast lymphedema occurs in approximately one-half of women who undergo breast surgery with axillary node removal. The condition is characterized by diffuse skin edema and erythema as well as self-reported symptoms with a low level of distress.

This is a confusing abstract, but the article has a great illustration showing the locations of the edema and erythema in breast LE, but these are women with lumpectomy and the whole issue changes with reconstruction. I've seen fluid trapped by scars.

The question is whether this is just LE or infection. And that changes treatment.

And let your PS know that LE can occur JUST in the breast/trunk.

Good luck

It started in my breast, then popped up in my arm while I was moving. Not sure it if "spread" or just happened.