The lymphatic system consists of thin vessels that transport lymph fluid. This system originates from small capillaries in the body's periphery, collecting fluid from tissues, guiding it through lymph nodes, and ultimately draining into the thoracic duct before it returns to the circulatory system.

Lymphedema is a condition where a limb becomes swollen and heavy, typically on the side that underwent surgery or injury. This condition may appear a few months after an operation or even many years later, long after recovery seems complete.

During breast cancer surgery, doctors often intervene with the axillary lymph nodes through procedures such as complete axillary lymph node dissection when cancer has spread, or sentinel lymph node biopsy. Many patients with axillary lymph node metastasis also receive adjuvant radiation therapy to this area. Both these approaches can damage the lymph nodes and lymphatic vessels, causing fluid to accumulate in the arm.

Doctor Khanh advises a patient. *Illustration: Tam Anh General Hospital*

The more extensive the axillary lymph node intervention, the higher the risk of arm lymphedema. The incidence of arm lymphedema is nearly 30% in patients who undergo complete axillary lymph node dissection, compared to about 5-6% in those who only have a sentinel lymph node biopsy.

In its early stage, the fluid in the tissues is still soft, so pressing on the skin leaves a noticeable indentation. If left unchecked, prolonged fluid retention stimulates the growth of fibrous and fatty tissues under the skin, leading to thickening and hardening of the limb.

Long-term accumulation of fluid and protein also impairs local immunity, creating a favorable environment for bacteria to thrive. Consequently, individuals with arm lymphedema are more prone to recurrent soft tissue infections than healthy individuals.

Patients should consult a plastic microsurgery specialist for early diagnosis and a treatment plan for lymphedema. The doctor may recommend advanced imaging techniques such as magnetic resonance imaging (MRI) or indocyanine green (ICG) lymphography.

Previously, the main treatments for lymphedema involved wearing compression stockings or three-layer bandages, combined with physical therapy exercises to aid lymphatic drainage, which patients often had to maintain almost lifelong. Today, thanks to advancements in reconstructive microsurgery, patients can undergo surgery to reduce swelling volume and restore physiological lymphatic drainage function.

Breast cancer patients who have undergone axillary lymph node dissection should regularly monitor the operated arm to promptly detect any abnormalities. Some hospitals offer integrated care involving breast cancer specialists, microsurgeons, rehabilitation therapists, high-resolution microsurgical microscopes, and ICG fluorescence imaging devices to effectively detect and treat lymphedema long-term.

Master, Doctor Tran Nguyen Nhat Khanh

Department of Surgical Oncology, Oncology Center

Tam Anh General Hospital, TP HCM