Lymphedema

At UT Southwestern Medical Center, we use the latest therapies to treat lymphedema – swelling that occurs when too much lymph fluid collects in a part of the body.

With a range of nonsurgical and surgical options, our multidisciplinary team designs the best treatment for each lymphedema patient to help manage their symptoms.

Expert Care for Lymphedema

Lymphedema occurs most often in the arms or legs. The swelling, which usually develops gradually, can extend to the hands and feet. It may become painful and limit range of motion in the affected area.

UT Southwestern’s expert physical medicine and rehabilitation specialists, cancer surgeons, and plastic surgeons provide exceptional care to lymphedema patients. In particular, we specialize in treatments for patients who develop lymphedema following surgery for breast cancer and other types of cancer.

Types of Lymphedema

Secondary lymphedema is the most common form of the disease. It is caused by damage to lymph nodes or vessels that results from another disease, such as cancer, lymph node infection, traumatic injury, or parasites.

Secondary lymphedema can also result from treatment methods for diseases, including radiation treatment for cancer and lymph node removal.

Primary lymphedema is a rare genetic form of the disease that causes lymph nodes or vessels to develop incompletely or not at all.

Symptoms of Lymphedema

The primary symptom of lymphedema is swelling, typically in the arms and legs. Other symptoms include:

• Arms or legs that appear to be different sizes
• Burning or itching sensation
• Clothes or jewelry that feels tighter than normal
• Fibrous/thick skin texture with a grainy appearance
• Inability to see veins and tendons in hands or feet
• Infections or wounds caused by swelling
• Limited range of motion in the affected area
• Pain or heaviness in the affected area
• Puffy, reddened skin
• Tightness in joints

Lymphedema Stages

Lymphedema progresses in four stages:

• Stage 0: The affected area feels tight or heavy but doesn’t appear swollen.
• Stage 1: The affected area looks swollen, but once elevated returns to normal.
• Stage 2: The affected area is swollen most of the time and the skin feels more rigid than in surrounding areas.
• Stage 3: The affected area is extremely swollen and the skin changes color and/or texture.

Diagnosing Lymphedema

After analyzing the patient’s symptoms and medical history, we may order the following diagnostic tests to confirm the presence of lymphedema:

• Bioimpedance spectroscopy: Also known as BIS, this test allows for early detection of lymphedema – even in stage 0. In BIS, a low-frequency electrical current is applied to the skin to measure extracellular fluid.
• Computed tomography (CT) scan: This test uses X-ray technology to discover possible causes of lymphatic malfunction.
• Lymphoscintigraphy: This scan uses radioactive material to find blocked or absent lymph vessels.
• Magnetic resonance imaging (MRI): Using a magnet and radio waves connected to a computer, this scan creates 3D pictures of the affected area to find possible causes of lymphatic distress.
• Ultrasound: This test monitors blood flow throughout the body to locate obstructions and find other potential causes of swelling, such as blood clots.

Lymphedema Treatment

Although lymphedema can’t be cured, there are several ways to successfully manage its symptoms. Treatment plans will likely include a combination of physical therapy and medical aids.

Treatments include:

• Bandages and compression garments: The wraps and fabric sleeves are designed to help move lymph fluid out of the swollen area, as well as keep it from returning.
• Compression devices: Similar to compression garments, these devices are connected to a pump that applies and releases pressure to prevent lymph fluid buildup.
• Elevation: Keeping the affected area elevated aids lymph drainage.
• Exercise: Physical therapists can guide you through low-impact exercises that support lymph drainage and help you restore strength to the affected area.
• Massage: Trained massage therapists can help move fluid from the affected area as well as teach how to perform such techniques at home.

Surgical options include lymphatic reconstruction (ILR) and delayed lymphatic reconstruction.

ILR is performed after breast cancer surgery. It uses an illuminated dye to help the surgeon reroute lymphatic fluid.

Options for delayed lymphatic reconstruction include:

• Debulking: Skin, fat, and tissue are surgically removed from your affected body part through liposuction, and then a skin graft is placed over the surgical area.
• Lymphaticovenous anastomosis (LVA): Lymphatic vessels are redirected and connected to veins to bypass obstructions in the lymphatic system. This method can be particularly successful in early-stage lymphedema.
• Vascularized lymph node transfer (VLNT): Another common option for early-stage lymphedema, VLNT replaces damaged lymph nodes with healthy ones from other parts of the body.