Lymphedema is actually mainly made up of fat and, to a lesser extent, a fluid part. These elements require a better understanding of prevention messages and management principles, insisted Dr. Stéphane Vignes (Cognacq-Jay Hospital, Paris) during the Pari(s) Santé Femmes congress (June 12-14, 2024, Paris).
We thus better understand the risk factors: post-operative infection, obesity, adjuvant treatment with taxanes, mastectomy and lumpectomy, absence of breast reconstruction, early edema in the first 4 weeks.
Overall, 50% of lymphedema occurs within two years following surgery. When it occurs, the first so-called intensive step consists of obtaining a volume reduction of 40 to 50% using a single-type bandage with little elasticity. Then, the maintenance phase is based on the use of elastic compression (sleeve). The prescribed sleeve must be tailor-made with an attached mitten to avoid fluid accumulation in the fingers. In cases of small lymphedema, studies suggest that the support sleeve is as effective as bandages and therefore avoids the initial phase of intensive reduction. Finally, pure prophylaxis should be distinguished from a slight onset of lymphedema (feeling of heavy arms, slight difference in arm circumference of 0.5 or 1 cm): these situations may justify the prescription of the sleeve.
Preventing lymphedema: countering preconceived ideas
« Blood tests, IVs or blood pressure measurements… are not harmful to women and do not constitute risk factors for lymphedema,” explains the specialist. “It is therefore important not to worry women unnecessarily with these misconceptions. » Similarly, manual lymphatic drainage is not indicated for the prevention of lymphedema. On the other hand, several elements can be effective in prophylaxis: supervised physical exercise, even intense (” including weightlifting “), which confirms that carrying loads such as water or milk packs does not pose any difficulties. Physical activity gradually adapted in intensity and frequency can be very interesting. And if the compression is bothersome during this activity, women can remove it and put it back on at the end of the activity. “ Due to its fatty composition, weight loss also helps prevent the occurrence of lymphedema. Finally, erysipelas is a sign that lymphatic drainage is fragile and can progress to lymphedema.
On the research front, other devices are being developed to make compression more convenient for women to use, such as the wrap (self-adjusting bandage, not refunded), “ easier to handle by patients, and which seems as effective as less elastic bandages in reducing volume.” LLymphedema surgery is an approach that also benefits from active research, but so far it has not resulted in concrete advances. Among the approaches that are being considered, the smartest is liposuction, followed by wearing a sleeve day and night for life. However, this constraint makes its wide use difficult. » Finally, many drugs are being tested to target certain mediators of lipogenesis or inflammation, but to date, none have been successful. Some seek to restore lymphatic drainage through biodegradable collagen or silicone devices.
“There is progress appearing, but slowly,” concluded Dr. Stéphane Vignes. “It also appears that women who develop lymphedema have a genetic predisposition. This will perhaps one day lead to a preliminary test to guide them towards preventive approaches. »
