Lymphoedema

Lymphoedema can start as mild swelling and eventually go on to affect movement, the skin or everyday activities. Understanding why it develops and to what extent the lymphatic system retains its drainage capacity makes it possible to tailor treatment to each individual.

What is lymphoedema?

The lymphatic system is a network of small vessels that collects fluid and proteins from the tissues and returns them to the bloodstream. Once inside the lymphatic vessels, this fluid is called lymph. Scattered throughout this network are the lymph nodes, small organs that play a part in defending the body against infections.

When the system is unable to transport all the fluid it needs to collect, it accumulates and lymphoedema develops. It usually affects one arm or one leg, although it can also occur in both limbs, the breast, the chest, the genitals or the head and neck. The location depends on which part of the drainage system is impaired.

Over time, the persistent build-up of fluid can also alter the tissues themselves. Swelling may occur, fatty tissue may increase, and fibrosis may develop – that is, a progressive hardening of the area. For this reason, a swollen limb does not necessarily contain only fluid: knowing which changes predominate helps in choosing the most appropriate treatment.

This summarises this progression and the importance of assessing both the fluid and the structural changes in the tissues together.

Symptoms of lymphoedema

The most recognisable change is persistent or recurrent swelling. At first, it may be subtle: a ring feels tighter, a sleeve feels snug or a shoe feels tighter, even though body weight has not changed.

Heaviness, tightness and a feeling of stiffness that makes certain movements difficult may also occur. In the early stages, the swelling is usually softer and may subside during rest or when the affected area is elevated.

As the problem persists, the skin may thicken and the tissues become firmer. Some people experience repeated infections; in more advanced stages, pronounced folds may appear or fluid may ooze from small skin lesions.

When swelling requires urgent attention

An area that becomes red, hot and painful, especially if it swells rapidly, may indicate an infection of the skin and the tissues beneath it. This is known as bacterial cellulitis and should not be confused with the cosmetic skin condition of the same name.

It may be accompanied by a fever, chills or general malaise, although the absence of a fever does not rule out infection.

A limb that swells suddenly may also have another cause, such as deep vein thrombosis – a blood clot inside a vein. This change requires urgent assessment, even if lymphoedema is already present. If it is accompanied by shortness of breath or chest pain, immediate attention is required.

Causes and risk factors of lymphoedema

The lymphatic system may have insufficient drainage capacity from the outset, or it may lose this capacity later as a result of illness, surgery or injury. This distinction gives rise to the two main types of lymphoedema: primary and secondary.

Primary lymphoedema

This is associated with abnormalities in the development or function of the lymphatic vessels. It can manifest in childhood, during adolescence or in adulthood; the fact that it appears later in life does not necessarily mean that there is an acquired cause.

Some cases have a genetic origin, but many occur without any known family history. The investigation is guided by the age of onset, the affected areas and other symptoms. Genetic testing is carried out when it can clarify the diagnosis or provide useful information to the family.

Secondary lymphoedema

This occurs when a disease, treatment or injury reduces drainage capacity. Causes include lymph node removal, radiotherapy, certain tumours, trauma and some infections.

Following cancer treatment, it may affect, for example, the arm after surgery in the armpit or the legs after treatment in the pelvis or groin. It may develop shortly afterwards or many years later.

Having lymphoedema does not in itself prove that cancer has returned, although any new swelling needs to be investigated to determine its cause.

Chronic venous disease can also play a part. When veins hinder the return of blood, the amount of fluid that the lymphatic system must drain increases and, over time, its capacity may become insufficient.

Following breast cancer treatment, regular monitoring is particularly important as it enables the detection of minor changes before swelling becomes apparent. This aspect is discussed in more detail later in the section on risk reduction and early detection.

What other conditions can cause similar swelling?

Not all persistent swelling is due to lymphoedema. It may be linked to venous problems, certain medicines, or heart, kidney or liver conditions. It is also possible for several factors to be at play in the same person.

Therefore, identifying a lymphatic component does not rule out the need to assess other factors that may be contributing to the increase in volume.

It is important to distinguish between lymphoedema and lipoedema, a condition characterised by a disproportionate and usually symmetrical distribution of fatty tissue in the limbs, accompanied by pain and tenderness.

In lipoedema, the feet and hands are usually spared, although this characteristic alone is not sufficient to establish the diagnosis. Lymphoedema and lipoedema are not synonymous, but they can coexist.

Treatment of lymphoedema

Treatment aims to control swelling and heaviness, protect the skin, reduce the risk of infection and maintain mobility and independence.

There is no single treatment plan that suits everyone. It is important to identify the cause, the affected area, the changes that have occurred in the tissues, and the extent to which the lymphatic system is still able to drain fluid.

For many people, treatment begins with non-surgical measures such as compression, exercise, skin care and self-care education.

When these measures are insufficient or the anatomy allows for reconstruction, specialised surgical techniques may be considered.

Decongestive therapy: reducing swelling and maintaining improvement

Complex decongestive therapy combines several measures that work in a complementary manner: compression, exercise, skin care, self-care education and, where indicated, manual lymphatic drainage.

It is called ‘decongestive’ because it aims to reduce fluid build-up.

In cases requiring more intensive treatment, the first step is to reduce the volume using specialised bandages and other measures. This is followed by a maintenance phase, involving the use of compression garments and care tailored to everyday life.

This second phase is part of the treatment: it does not mean that the first phase has failed. Its purpose is to help maintain the improvement whilst drainage difficulties persist.

Compression: why it is a central part of treatment

Compression sleeves, stockings, gloves and bandages exert controlled pressure on the tissues. They help to limit fluid build-up and, when combined with muscle movement, promote the drainage of fluid.

The choice depends on the affected area, its shape, the condition of the skin and the pressure required. It is also important that the person is able to put the garment on and use it correctly.

Before prescribing compression, circulation is assessed, particularly where there is arterial disease in the legs. If a garment causes pain, numbness or changes in skin colour, it needs to be reviewed: greater pressure is not necessarily more appropriate.

What manual lymphatic drainage offers

Manual lymphatic drainage uses gentle, specific movements on the skin to encourage the flow of fluid towards areas where drainage is more effective.

It is neither a deep tissue massage nor a cosmetic treatment.

Its added benefit varies from person to person. For this reason, it is used to address a specific need, integrated with compression, exercise and other forms of care, rather than being presented as a sufficient solution in its own right.

Exercise and skin care

Muscle movement helps to transport lymph. Walking, performing mobility exercises and gradually building strength can form part of the treatment.

The activity is tailored to the person’s physical ability, symptoms and previous treatments. Having lymphoedema does not mean that the limb must be kept at rest at all times.

Skin care helps to preserve the skin’s barrier function. Keeping the skin clean and moisturised, looking after minor wounds and treating cracks or fungal infections reduces potential entry points for infections.

Pneumatic compression or pressotherapy

Intermittent pneumatic compression, also known as medical pressotherapy, uses a sleeve or boot connected to a device whose chambers inflate in succession.

The pressure helps to mobilise fluid and can complement other forms of care, particularly during the maintenance phase.

Its indication, pressure and duration must be tailored to each individual. These devices do not automatically replace compression garments, exercise or skin care.

Medicines and treatment of infections

Diuretics, medicines that increase the excretion of water in the urine, are not the standard treatment for isolated lymphoedema.

They may be indicated when there is another condition that requires them, but they do not, on their own, correct the lymphatic system’s difficulty in transporting fluid.

Bacterial infections require antibiotics. When they recur, the medical team checks for possible entry points in the skin, monitors the swelling and assesses the need for additional preventive measures.

Progression and prognosis of lymphoedema

Lymphoedema usually requires long-term care, but its progression varies.

A significant improvement does not always mean that the arm or leg will return exactly to its previous size. It may also mean feeling less heaviness, moving more easily, suffering fewer infections or requiring less effort to carry out everyday activities.

Regular check-ups allow the skin, mobility, tolerance to compression and volume to be assessed. If your needs change, treatment should be adjusted rather than continued out of habit.

Just because lymphoedema is a chronic condition does not mean there are no options for improving its symptoms or its impact on daily life.

Risk reduction and early detection

The risk of lymphoedema cannot be completely eliminated. Where there is an underlying disorder of the lymphatic system or where lymph nodes have had to be treated due to cancer, the strategy focuses on reducing avoidable risks, recognising early changes and taking action before the swelling becomes established.

Lymphoedema following breast cancer

Breast cancer is one of the contexts in which the prevention of lymphoedema has been most extensively studied.

The risk depends particularly on the treatment carried out in the armpit. Selective sentinel lymph node biopsy, which examines one or a few lymph nodes, is associated with less lymphoedema than axillary lymphadenectomy, in which a larger number of lymph nodes are removed. A systematic review found a higher incidence of lymphoedema and other arm abnormalities following lymphadenectomy than following sentinel lymph node biopsy.

Radiotherapy to lymph node regions and individual factors may also increase the risk, particularly when combined with more extensive axillary surgery.

This does not mean that a particular procedure will necessarily lead to lymphoedema. It helps to identify which individuals may benefit from closer monitoring.

Monitoring before visible swelling appears

In patients at higher risk, it may be useful to take a baseline measurement before treatment or at an early stage of follow-up and to repeat this measurement later.

The aim is to detect small changes in fluid or volume before the arm becomes noticeably swollen.

Bioimpedance can form part of this monitoring approach. Clinical recommendations based on the PREVENT trial indicate that combining regular measurements with early compression intervention when changes occur reduced progression to chronic lymphoedema compared with monitoring based solely on tape measurements.

Prevention through cancer treatment itself

A significant part of risk reduction begins during the planning of cancer treatment.

Where the nature of the cancer allows, modern strategies aim to avoid more extensive axillary surgery than is necessary. Sentinel lymph node biopsy results in less arm morbidity and less lymphoedema than complete lymphadenectomy in situations where it is oncologically appropriate.

The priority remains the correct treatment of the cancer. Decisions regarding lymph nodes or radiotherapy are made according to oncological criteria and should not be altered solely with the aim of avoiding potential lymphoedema.

Immediate lymphatic reconstruction in selected patients

When a patient requires an axillary lymphadenectomy, certain specialist centres may consider an additional strategy: immediate lymphatic reconstruction.

The procedure is carried out during the axillary surgery itself. It involves identifying lymphatic vessels that have been severed and connecting them to small veins using microsurgery, with the aim of maintaining a drainage pathway and reducing the likelihood of lymphoedema developing later on.

The evidence is promising, but is still evolving. Preliminary results from a randomised trial found a lower incidence of lymphoedema following immediate reconstruction, whilst another prospective study observed no significant difference.

It should therefore not be presented as a guarantee of prevention. Its potential indication depends on the patient’s risk, the type of axillary surgery, the technical feasibility of identifying suitable vessels, and the team’s experience.

The scientific profile of the [publication] includes specific research on immediate lymphatic reconstruction and targeted axillary lymphatic repair for the prevention of lymphoedema.

The Hospital has also recently publicised the concept of , explaining how the protection or reconstruction of lymphatic pathways can be integrated into certain oncological scenarios.

Day-to-day care and risk reduction

Following cancer treatment, prevention does not mean constantly worrying about your arm or imposing a host of restrictions on yourself.

Maintaining a gradual level of physical activity, looking after your skin, treating infections promptly and seeking advice if changes persist are all part of a sensible approach.

Monitoring should be tailored to individual risk. The aim is for the person to know which changes are worth keeping an eye on, without turning everyday activities into a constant source of worry.

Specialists who treat lymphoedema

At the Publio Cordón Memorial Hospital, the specialised approach to lymphoedema is centred on the Advanced Breast Reconstruction and Lymphoedema Unit, which forms part of the Plastic and Reconstructive Surgery Department. The Unit is specifically dedicated to the assessment and surgical treatment of lymphoedema, including that which occurs following treatment for breast cancer.

The assessment is not limited to measuring how much an arm or leg has swollen. The aim is to determine the lymphatic system’s remaining drainage capacity, what changes have occurred in the tissues, which symptoms are affecting the patient’s daily life, and which treatments can provide a real benefit in that specific case.

Where indicated, the Unit utilises advanced techniques in lymphatic microsurgery and supermicrosurgery. These include lymphatic-venous anastomoses (LVAs), which create new connections between small lymphatic vessels and veins, and the transfer of vascularised lymph nodes, which relocates functional lymphatic tissue to the affected region. The choice depends on the anatomy, the condition of the lymphatic vessels and the individual’s specific characteristics.

The Unit is headed by Dr Jaume Masià Ayala, a specialist in Plastic, Reconstructive and Aesthetic Surgery with a specific focus on microsurgical treatment of lymphoedema. His professional profile includes experience in lymphatic-venous anastomosis, microsurgical lymph node transfer and the surgical treatment of lymphoedema, as well as research into lymphatic reconstruction and the prevention of breast cancer-related lymphoedema.

The team also includes Dr José María Lasso, who specialises in reconstructive microsurgery and supermicrosurgery applied to lymphatic disorders, and Dr Gemma Pons, a specialist in lymphoedema surgery and reconstructive surgery of the lymphatic system.

In people who have been treated for breast cancer, this specialism takes on particular importance. Lymphoedema can develop following axillary surgery or radiotherapy, even years after treatment. The Unit itself integrates the reconstructive and lymphatic approaches and works in coordination with the hospital’s oncology departments to ensure oncological safety, prevent long-term effects and facilitate functional recovery within a single care pathway.

Conservative treatment — compression, exercise, skin care, physiotherapy and self-care — remains an important part of management when indicated. The existence of a highly specialised surgical unit does not mean that everyone with lymphoedema requires surgery: rather, it enables us to determine precisely which patients may benefit from microsurgery, which technique may be appropriate, and when it is preferable to maintain or adjust other measures.

Living with lymphoedema

Living with lymphoedema isn’t just about keeping track of the measurements of an arm or a leg. It also means wearing compression garments, looking after your skin, adapting certain activities and learning to recognise when something is changing.

Effective treatment must be sustainable in everyday life. If a garment is impossible to put on, interferes with work or causes discomfort, the response shouldn’t simply be to persist: it may be necessary to review the fit, the type of compression or the approach.

Adapting care to everyday life

A useful plan must take into account the ability to put on the garments, daily schedules, the physical demands of work and the possibility of receiving help.

When compression garments prove difficult to use, adjusting their fit or exploring alternative systems may be more helpful than sticking to a regimen that cannot be followed.

Learning self-care is a gradual process and should enable the person to integrate their care into their home life.

Maintaining the activities that matter

Physical activity should be tailored to the person’s ability and symptoms. Resuming walks, hobbies and everyday movements is part of the functional objective, not just an exercise routine.

When difficulties arise with work, rest or socialising, these should be discussed during consultations.

The aim is for treatment to help restore independence without making the illness the focus of all daily decisions.

Preguntas frecuentes

Can lymphoedema be cured?

It is usually a chronic condition, but there are treatments available that can reduce swelling, discomfort and complications. The extent of improvement and the need for long-term care depend on the cause, the changes that have occurred in the tissues and the response to treatment.

Does having lymphoedema mean you have cancer?

No. It may be due to disorders of the lymphatic system itself, venous diseases or other causes. It may also occur following cancer treatment without this necessarily indicating a relapse. The cause of any new swelling needs to be investigated.

Do all women treated for breast cancer develop lymphoedema?

No. The risk depends, amongst other factors, on the treatment carried out in the armpit, radiotherapy and individual circumstances. A sentinel lymph node biopsy is generally associated with a lower risk than an axillary lymphadenectomy. For those at higher risk, targeted surveillance may be considered.

Can lymphoedema be detected before the arm swells up?

In certain monitoring programmes, early changes can be detected through serial measurements, including bioimpedance. These findings are interpreted in conjunction with the clinical examination and may enable measures to be taken before lymphoedema is clearly established.

Can lymphoedema following breast cancer be prevented surgically?

In selected patients requiring an axillary lymphadenectomy, immediate lymphatic reconstruction may be considered during the same procedure. The evidence is promising, but it does not guarantee that lymphoedema will not develop, and the technique is not indicated for all patients.

Are lymphoedema and lipoedema the same thing?

No. Lymphoedema is associated with an inability of the lymphatic system to drain fluid effectively. Lipoedema, on the other hand, is characterised by a painful abnormality of the fatty tissue. The two conditions can occur together, so it is important to distinguish between them.

Is manual lymphatic drainage enough?

Answer: It is not usually used as a stand-alone treatment. Where it is indicated, it forms part of a combined strategy in which compression, exercise and skin care each play a different role.

Can I exercise if I have lymphoedema?

Exercise is usually part of the treatment. It is started or resumed gradually, adapting it to the affected area and the patient’s physical ability. A sudden increase in swelling or pain requires assessment before continuing.

Does surgery mean you can stop wearing compression garments?

Answer: It cannot be guaranteed. Some procedures improve drainage or reduce the need for treatment, but many people still require compression. Following liposuction for lymphoedema, continuing to wear compression garments is usually essential to maintain the results.

What is an LVA?

LVA, or lymphatic-venous anastomosis, is a microsurgical technique that connects small lymphatic vessels to nearby veins to create an alternative drainage route. It is not suitable for all cases of lymphoedema and requires a prior assessment to determine which vessels are still functioning.

Medical information for general guidance

Lymphoedema requires an assessment that distinguishes between fluid accumulation and changes that have occurred in the skin and tissues. Understanding these differences helps to explain why compression, exercise, skin care and, in certain situations, surgery are combined.

In people who have been treated for breast cancer, this same understanding enables action to be taken even before established lymphoedema develops: recognising the risk, monitoring early changes and assessing preventive strategies where indicated are all part of an increasingly personalised approach to care.

At the Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each person throughout their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and participate with greater confidence in decisions about their health. This commitment to knowledge and public outreach is also part of our dedication to research and scientific dissemination.

This information is intended to provide guidance on the condition and is not a substitute for an individual assessment. Any new or persistent swelling should be investigated; if it increases suddenly or is accompanied by redness, warmth or pain, urgent attention is required. Difficulty breathing or chest pain requires immediate attention.