Truncal Lymphedema

DESCRIBING TRUNCAL LYMPHEDEMA

Truncal lymphedema is often misdiagnosed, or undiagnosed, and patients with excessive fullness and/or pain in the breast, chest, lateral trunk, armpit or back are living with post-treatment discomfort.

In response to the many requests Bellisse has received for more information about truncal lymphedema signs and symptoms, we have created this page. The images and descriptions below will give you an idea of how this problem may present or what it may look like – of course you should always consult with your doctor or lymphedema therapist to be sure.

Truncal lymphedema is common following breast cancer surgery, but it can also occur after treatment for lung cancer (a lobectomy and radiation treatment). Complete Decongestive Therapy (CDT) in conjunction with compression therapy is the standard treatment for truncal lymphedema around the world.
Post treatment edema can last for weeks or even months after surgical procedures such as breast reduction and augmentation, and could often be more comfortably managed with a bra that provides comfortable compression, that is adjustable circumferentially, and that has cups that can conform to the shape of the healing tissue.

Truncal lymphedema frequently develops following breast or lung cancer treatment and can be present with or without significant involvement of the adjacent arm.

Some studies suggest that up to 80% of women may develop truncal lymphedema after certain breast cancer treatment procedures including breast reconstruction, yet this condition is still often under diagnosed and under treated.

SYMPTOMS OF TRUNCAL LYMPHEDEMA

• Pain, particularly in the shoulder region, is usually more severe than the discomfort associated with lymphedema of the arm.
• Anterior chest wall swelling that is most commonly located in the affected breast, or chest wall, over the collarbone (area of the neck), in the axillary cavity (the area under the arm), along the scar lines, or on the inner surface of the upper portion of the adjacent arm.
• Swelling of the back usually appears as extra rolls of fat along the side of the trunk, fullness over the shoulder blades or upper back, and (if the right side is affected) fullness across the waistline on the right side of the trunk.
• Swelling of the arm may, or may not, be present. Differential diagnosis of truncal lymphedema can be difficult if the patient does not also have swelling lymphedema of the upper extremities.
• Reconstruction complaints include that the reconstructed breast is too large, misshapen, and uncomfortable during the activities of daily living.

DAILY TREATMENT MODALITIES

Bellisse Compressure Bra

• Compression, through the use wrapping with bandages around the chest, is NOT PRACTICAL because the patient must be able to breathe properly. Therefore specialized alternative methods, such as the Compressure Comfort Bra, as shown here, was designed to meet these compression needs. The wide straps, flexibility of fitting, and unique under arm design provide comfort and compression.
• Daily massage sessions are very important in managing truncal lymphedema because it helps to compensate for the difficulty in obtaining compression. It is also very important in removing excess fluid, softening fibrotic tissues, and easing pain in these affected areas.
• Manual Lymph Drainage (MLD) is performd by the patient's therapist during treatment sessions
• Self-massage is performed at home to the best of the patient's ability.
• Simple Lymph Drainage (SLE) is performed by a caregiver in order to reach areas that the patient cannot reach.
• The term tourniquet effect describes any garment that blocks, or slows, blood or lymph drainage.
• Avoid a heavy prosthesis because it places pressure against the chest wall, but not where you want compression. It also drags on the bra straps. Wearing a light-weight prosthesis can ease this problem. The prosthesis shown be light in weight and flexible to suit the patient's needs for realistic appearance.
• Never wear an underwire bra. Some studies, which have not been fully documented, suggest that an underwire may contribute to the development of breast cancer or lymphedema.
• Avoid narrow bra straps. Straps that dig into the shoulders block the flow of lymph at the terminus. Wearing a bra with wide padded straps, such as those in a soft sports bra, are more comfortable. A zipper opening down the front makes donning and removing this bra easier.
• Avoid constriction around the chest. If the lower band of a bra band is too tight, and without elasticity, it blocks the flow of lymph. Therefore the bra band should be wide and flexible.
• Avoid constriction around the waist. This includes tight waistbands on clothing and long-line bras. They have a girdle-like effect around the waist that blocks the flow of lymph.

ADDITIONAL HELPFUL TECHNIQUES

JoVi Chest Pad (Courtesy of JoVi Pak.)

Specialized quilted compression pads, such as the one shown here, are worn under a sports bra. These aids encourage lymph drainage and help to soften fibrotic tissue. These are available from several manufacturers and are often custom made to fit the areas of greatest need.

Exercise is particularly important in managing truncal lymphedema. The movements of the muscle pumps and the flexing of the joint pumps, stimulate the natural flow of lymph. Exercises in chest deep water is particularly beneficial because the pressure of the water provides compression over the entire affected area.

REFERENCES

• Lymphedema Caregiver's Guide M. K. Kearse, PT, Clt-LANA, E. McMahon, PhD, and A Ehrlich, MA. Lymph Notes, 2009
• Living Well with Lymphedema by A. Ehrlich MA, A. Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes. 2005.

© LymphNotes.com 2011.This information does not replace the advice of a qualified health care professional.

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Category: What is Lymphedema? Updated: 2012-07-13