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Managing
BCRL Is a Superpower

There is no known cure for BCRL, but early diagnosis and diligent treatment can improve outcomes.

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That's why we started Athena Aftercare:

To help breast cancer survivors better understand this pretty terrible lifelong condition, monitor for it and provide information and resources to help manage it.

What You Should Know

What is Lymphedema?

Lymphedema (lim(p)-fi-ˈdē-mə) is caused by faulty lymphatic drainage, leading to the accumulation of lymph fluid in tissues that, when left untreated, can cause damage. People can have primary lymphedema, a rare genetic condition that impacts 1 in 100,000 individuals. More commonly, 1 in 1,000 Americans can develop secondary lymphedema which occurs when the lymphatic system is damaged by infection, injury or blockage.

What is BCRL?

Breast Cancer-Related Lymphedema (BCRL) is a type of secondary lymphedema that can impact between 40-70% of breast cancer survivors at some point in their life. Many survivors develop BCRL within months or a few years of their cancer treatment. However, for some, lymphedema symptoms may not occur until many years, even decades, later. Science points to a "triggering event" that will overwhelm the damaged lymphatic system, leading to the onset of lymphedema.

How BCRL Develops

Lymph Node Removal: During breast cancer surgery, lymph nodes in the armpit (axillary lymph nodes) are often removed to check for cancer spread. This can disrupt the natural flow of lymphatic fluid, causing it to accumulate. Axillary Lymph Node Dissection (ALND): When a significant number of lymph nodes are removed, the risk of BCRL is higher. Sentinel Lymph Node Biopsy (SLNB): This procedure involves removing only the first few lymph nodes that drain the breast, carrying a lower risk of lymphedema compared to ALND. Radiation Therapy: Radiation to the armpit or chest area can also damage lymphatic vessels, leading to scarring and blockages that hinder fluid drainage. Other Factors: Obesity, infections, and certain medical therapies can further increase the risk or trigger BCRL.

Managing BCRL

BCRL is a lifelong condition with no cure, but it can be managed. Management typically involves a combination of therapies aimed at reducing swelling and preventing complications: ​ Manual Lymphatic Drainage (MLD): A gentle massage technique to encourage lymph fluid movement. Compression Therapy: Wearing compression sleeves or bandages to help reduce swelling and support fluid drainage. Exercise: Specific exercises prescribed by a physical therapist to improve lymph flow and maintain range of motion. Skin Care: Meticulous skin care to prevent infections, as affected areas are more susceptible. Weight Management: Maintaining a healthy weight can help manage symptoms. Early detection and consistent management are crucial for controlling BCRL and improving well-being.

Learn More

  • There Are Four Stages of Lymphedema

    Stage 0 (also called latent or subclinical)

    People with stage 0 lymphedema have no visible swelling (edema) or pitting, which refers to a temporary indentation in the skin when you press it. You may notice a mild tingling or slight heaviness or tightness in the affected area. You can have stage 0 lymphedema for months or years before obvious symptoms develop.

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    Stage 1 (early or mild lymphedema)

    People with stage 1 lymphedema have visible swelling as lymph starts to accumulate. Although a temporary small dent (or pit) forms when you press the skin, there is no permanent damage to the skin or underlying tissues.

    Specialists consider this early-stage lymphedema to be reversible. If your arm is swollen, it can go back to normal when you elevate it.

    Once you have mild lymphedema, your risk for developing moderate lymphedema is higher than someone who has never had any symptoms — even if your symptoms go away with treatment.

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    Stage 2 (moderate lymphedema)

    People with stage 2 lymphedema have visible swelling with pitting and a higher risk of infection. Elevating the affected area does not help. This means there is inflammation, hardening, or thickening of the tissue under the skin.

    As scarring of soft tissue under the skin worsens, pitting may disappear. Your specialist can help you manage stage 2 lymphedema with treatment, but tissue damage is not reversible.

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    Stage 3 (severe lymphedema)

    People with stage 3 lymphedema — the most advanced stage — have visible swelling, and the affected area enlarges and becomes misshapen. There is also a higher risk of infection. The skin hardens and thickens so much there is no pitting, and lymph can leak through damaged tissue.

    Stage 3 lymphedema is relatively rare in people diagnosed with breast cancer.​​

    Information Sources:

    • BreastCancer.org

    • Sleigh BC, Manna B. Lymphedema. [Updated 2023 Apr 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537239/

    • International Society of Lymphology

  • BCRL Symptoms Can Include:

    Most often, swelling from lymphedema occurs slowly. People first notice their shirt sleeves become tight at the upper arm or the arm feels heavy or "full". Sometimes indentations at the bra line or over the breast are more prominent. Some patients report their breast has become "hard" in some places. Occasionally, swelling can develop quickly after a triggering event. If you develop a large quantity of swelling in a short amount of time, evaluate for possible infection (signs are skin being hot, red, painful). Again, swelling can be in the arm and/or breast and/or trunk.

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    ​BCRL Symptoms Can Include:

    • Swelling: This is the most prominent symptom, ranging from mild puffiness to severe enlargement of the affected limb or area.

    • Feeling of fullness, heaviness, or tightness: The arm, hand, or chest may feel uncomfortable or weighed down.

    • Pain or aching: Discomfort in the affected area.

    • Changes in skin: The skin may feel tight, thickened, or have a pitted appearance.

    • Reduced flexibility or movement: Difficulty bending or moving joints in the affected limb.

    • Clothing or jewelry feeling tighter: Rings, watches, or bra straps may suddenly feel too snug.

    • Weakness or fatigue in the arm.

    Information Sources:

    • Dr. Katherine Bunker, PT, DPT, CLT at Renown Health

  • Cording or Axillary Web Syndrome

    Thought to be a result of injury/trauma to axillary lymphatics or part of lymphatic overload. This is possibly due to an interruption of the lymphovenous channels which causes hardening and pooling of the lymphovenous fluid, resulting in inflammation, fibrosis, and shortening of the tissue. Also known as "cording".

    • Usually feels like a long tendon beginning in the armpit and traveling down the arm or down the side of your ribs

    • Can extend all the way to the elbow, wrist, and thumb.

    • Can be painful and most often restricts overhead motion of the arm

    • Not permanently restrictive! Gentle stretching and arm movement can reduce the cord adhesions if you're not moving the arm very much. If you are over-moving the arm, that can cause cording as well. If not making progress with the cording, consider an evaluation.

    Information Sources:

    • Dr. Katherine Bunker, PT, DPT, CLT at Renown Health

    • Zuther, Joachim & Norton, Steve, Lymphedema Management: The Comprehensive Guide for Practitioners, Thieme, 2017.

  • Reduce Your Risk

    The goal is to avoid triggering the onset lymphedema. Lymphedema can present itself immediately after surgery/radiation, months later, years later, or never. Protecting the arm on the side of the surgery (the affected arm) from injury and infection is very important after breast surgery. There are MANY factors that influence the development of lymphedema which is why risk reduction is key.

    • Try to avoid injuries to the skin near the affected area. For example: wearing gloves during gardening, using bug spray to ward off mosquitos, covering your limb while playing with pets, keeping nails clean and avoiding cutting too close to cuticle, utilizing electric razors at the armpit (instead of a traditional razor), requesting blood draws on another limb (be mindful of the tourniquet), and having tattoos/piercings performed on an alternative area

    • Try to avoid blood pressures to the affected limb. The lymphatics are very superficial! If there is no avoiding the limb (maybe both axillas have had treatment and a leg is not an option) request blood pressure to be taken manually, not by a machine.

    • Try to avoid heat. This includes saunas, hot tubs, sunburns, hot packs, and even massages. It's ok to have a massage in other areas of the body, just be mindful of your affected area.

    • Try to avoid tight jewelry. Occasionally, rings or bracelets can be too tight which can cause atourniquet.

    Information Sources:

  • Treatment

    Before you begin breast cancer treatment, ask your medical provider about therapy to support your healing process. Best practice is to meet with a certified BCRL therapist prior to surgery. They help manage and reduce the common side effects of breast cancer treatment, including pain, stiffness, limited range of motion and BCRL.

    ​

    Complete Decongestive Therapy (CDT) is the gold standard treatment for BCRL. It's a non-invasive approach that combines multiple therapeutic techniques to reduce swelling, improve lymphatic drainage, and enhance quality of life. CDT is typically divided into two phases: an intensive phase and a maintenance phase. 

    Learn More

    Information Sources:

    • Dr. Katherine Bunker, PT, DPT, CLT at Renown Health

    • Christina Bach, MBE, LCSW, OSW-C; Treatment for Lymphedema: Complete Decongestive Therapy, University of Pennsylvania OncoLink, February 2024.

  • Frequently Asked Questions

    Is Exercise Okay?

    Yes!! Do not be afraid to use your arm! (Unless your surgeon has given you specific precautions.)

    • In general, heavy lifting or overstraining your arm is not advisable. Consider carrying groceries with the other arm or vacuuming with the opposite arm.

    • Check your arm during or after your exercise to see if it has changed size or shape.

    • If your medical care provider has prescribed a compression sleeve to wear while exercising, make sure you do so.

    • Follow post-op guidelines.

    Information Sources:

    • Dr. Katherine Bunker, PT, DPT, CLT at Renown Health

Information Sources:

• Donahue, P. Advances in the Prevention and Treatment of breast Cancer-Related Lymphedema [2023 April 6].  In: Breast Cancer Research and Treatment.  https://lymphoedemaeducation.com.au/wp-content/uploads/2023/05/Advances-in-treatment-of-BCRL.pdf • Fu MR. Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. World J Clin Oncol. 2014 Aug 10;5(3):241-7. doi: 10.5306/wjco.v5.i3.241. PMID: 25114841; PMCID: PMC4127597 • https://www.nhs.uk/conditions/lymphoedema • American Cancer Society: https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/lymph-node-surgery-for-breast-cancer.html • Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682 • Singh AP, Singh A, Arya R, Naik A, Gurjar OP. Prevalence of Lymphedema and Associated Risk Factors Following Multimodal Breast Cancer Treatment. J Med Sci Health 2023; 9(3):310-315 https://jmsh.ac.in/articles/prevalence-of-lymphedema-and-associated-risk-factors-following-multimodal-breast-cancer-treatment

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