Following breast cancer surgery

This past weekend at Stanford University Jean-Paul Belgrado, PT, a leading Belgium researcher for the past 30 years from the Universite Libre de Bruxelles in the field of lymphedema, presented an amazing conference on breast cancer surgery, and the possible reasons that lymphedema and venous problems occur in some people and not in others following surgery. He stated that approximately 20 percent of patients would have lymphedema after surgical interventions for breast cancer. What we want to know is, why do the other 80 percent have no side effects from their surgical interventions because this will help us determine how to prevent these side effects for the other 20 percent.

Here are some of the possible reasons why lymphedema and venous edema can happen after breast cancer:

1) Surgical Intervention. What type of breast cancer surgery did they have? Was there an axillary re-section with lymph nodes removed? Or was it only a sentinel lymph node? If there was an axillary dissection performed, was the sheath of the axillary vein compromised when the nodes were removed? Where are the scar lines located? Are there multiple scars lines blocking the fluid flow patterns?

2) Chemotherapy. They have evidenced that certain drug interventions produce an inflammatory response and this increases the possibly of lymphedema. A physician in the EU has recently documented a list of meds that have been noted to increase this level of edema.

3) Radiotherapy. It has been seen that with radiation of the breast tissue and the axillary region, you can compromise the fluid movement patterns. All patients who have had radiation need to have an evaluation to determine skin integrity and scarring in the area of radiation and surrounding tissue.

4) Scar tissue. The scar lines are significant in how the pattern of fluid can move. If they are restricted, thick, hard and immobile, then backflow of the fluid can occur around and behind the scar lines.

5) Genetic. It has been evidenced that there is a genetic tendency towards edema in certain groups and populations.

6) Physical Activity. What is your level of physical activity at work, home and in you community life? There must be a balance in your activity level where you are activating the muscle pump, but not increasing the level so high, with such repetitive activities, that you create an inflammation.

7) Body Mass Index. The level of obesity present affects the amount of fluid that might occur. The higher the BMI, the greater the likelihood of edema that can occur - especially if over 30 percent.

The above list needs to be considered and looked at to determine if you are at risk for lymphedema. Because of this, all breast cancer patients should have a baseline examination with a physical therapist trained in this type of care as soon as their drains are removed or 12-14 days after surgery to establish a baseline evaluation so that lymphedema and venous issues can be prevented and cared for early on, if they are at risk.

Sheree DiBiase, PT, and her staff can be reached at Lake City Physical Therapy (208) 667-1988 or in the Spokane Valley office at (509) 891-2623 for a baseline evaluation, prevention and a complete care program after breast cancer surgery. She has a specialization in breast cancer care and has trained at Stanford University in lymphedema. Don't wait - you are in charge of your own health care program. Come see us!