• Posted December 8, 2023

Lymphedema Left her 'Miserable, Depressed' Until Specialized Surgery Changed Everything

Sydnee Meth survived breast cancer, but she wasn't prepared for the aftereffects of her treatment.

Doctors removed the lymph nodes from Meth's right armpit during her second bout with breast cancer in 2014, and as a result she developed a painful condition called lymphedema.

For years, her right arm was so swollen and heavy she couldn't lift it up past her shoulder. She couldn't find blouses that fit. Even simple tasks like blow-drying her hair were difficult to impossible.

"I was miserable, depressed and didn't have much of a life,"Meth recalled.

"I had been to a physical therapist and had been wrapping my arm to help with the swelling, but that wasn't working. I was losing hope,"Meth added.

Meth finally found relief from, of all things, plastic and reconstructive surgery. Doctors essentially rewired her body to relieve the swelling in her right arm.

"I have a life now,"Meth said. "Before surgery, I was not managing well. Now, I am."

Coordinating care

Lymphedema happens due to a change or dysfunction in the lymphatic system, a network of organs, vessels and tissues that work together to move lymph fluids around the body.

In lymphedema, those fluids are blocked from draining through the lymphatic system and start collecting in the arms and legs, causing swelling.

In Meth's case, lymphedema occurred after removal of her right armpit's lymph nodes as part of her breast cancer surgery. It grew worse after multiple rounds of radiation therapy to treat her cancer.

Lymphedema affects as many as two in five breast cancer patients who have lymph nodes removed, according to the National Institutes of Health. It also can affect people who receive surgery and radiation therapy for other cancers.

"There is no cure for lymphedema, so the goals of treatment are to improve symptoms and quality of life,"said Meth's physician, Dr. Ketan Patel, a plastic and reconstructive surgeon at Cedars-Sinai Medical Center.

"We put patients on the right treatment path for them, making appropriate referrals or performing surgery as needed,"Patel added in a Cedars-Sinai news release. "In many ways, we coordinate lymphedema care because not everyone is a surgical candidate."

Rewiring the system

Patel started Meth's treatment by performing surgery to move lymph nodes from her abdomen to her right armpit, essentially rewiring her lymphatic system to improve drainage.

Three weeks after the surgery, Meth's swelling had decreased to the point she was able to fit her arm into a dress she'd been unable to wear.

Patel also referred Meth to complete decongestive therapy, in which specialized therapists perform massage that encourages lymph drainage, apply compression wrapping to swollen limbs and guide patients through specific exercises.

The decongestive therapy further reduced Meth's pain and swelling, and improved her arm's movement and function.

Other surgeries further improved her condition. Patel performed liposuction to remove extra fat from her right arm that had accumulated due to lymphedema, and also rerouted part of her lymphatic system in a procedure called a lymphovenous bypass.

Better awareness needed

Meth hadn't known any of this was possible for her condition.

"I feel that the lymphedema patient community needs more information,"Meth said in the Cedars-Sinai news release. "People need to know where to go for help. I had been to a physical therapist and had been wrapping my arm to help with the swelling, but that wasn't working. I was losing hope."

Patel says there needs to be better awareness of both lymphedema and treatment options for the condition.

"Treatment for lymphedema has, for the most part, still been relegated to therapy,"Patel said. "There is no medical treatment administered by a doctor, so the surgical techniques that we offer are just starting to gain more traction."

For example, patients would be better served if doctors did a better job screening them for potential lymphedema, and getting ahead of the condition before it develops, Patel said.

"If we can identify patients who are at a higher risk of developing lymphedema, then we can have them see a therapist before surgery, get them wrapped at the time of surgery, and basically treat patients like they already have lymphedema in hopes that we prevent long-term swelling,"Patel said.

"It's not just rehab after the fact, but prehab, before the fact,"Patel added. "In the future, we see this being at the forefront of lymphedema treatment planning for all at-risk patients."

More information

Johns Hopkins Medicine has more about lymphedema.

SOURCE: Cedars-Sinai Medical Center, news release, Dec. 6, 2023