Truncal Lymphedema

Introduction

Truncal lymphedema, which affects the chest region, 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.

To see excellent photographs of the many forms of truncal lymphedema, go to the site What does Truncal Lymphedema look like? These photos were originally published in the Bellisse newsletter.

Symptoms

• Pain, particularly in the shoulder region, is usually more severe than the discomfort associated with lymphedema of the arm.
• Anterior chest wall swelling 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.

Treatment Modalities

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.

Compressure Comfort BraŽ (Courtesy of Bellisse)

Compression, with the use of 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 shown here are designed to meet these compression needs. The wide straps, flexibility of fitting, and unique under arm design provide comfort and compression.

The term tourniquet effect describes any garment that blocks or slows 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.

Kinesio tape when properly placed also helps to drain excess fluid from the tissues of the back. To learn more, read Kinesio Taping

Exercise

Exercise is particularly important in managing truncal lymphedema. The movements of muscles, known as muscle pumps, and the flexing of joints, know as 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. See Water Exercises for Lymphedema.

References

[1] Lymphedema Caregiver's Guide M. K. Kearse, PT, Clt-LANA, E. McMahon, PhD, and A Ehrlich, MA. Lymph Notes, 2009.

[2] Living Well with Lymphedema by A. Ehrlich MA, A, Vinjé-Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes. 2005.

[3] Truncal Lymphedema by E. Muscari-Lin, RN, MSN. APRN, BC, AOCN. Lymph Link, Vol 16, No 1, January-March 2004.

© 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: 2011-01-10