Is Lymphedema Common After A Simple Lumpectomy And What Is The Treatment?

Question

Asked by Susan Monroe

Is Lymphedema Common After A Simple Lumpectomy And What Is The Treatment?

In January of 2008 I had a lumpectomy done and then received chemo from Feb 1st to April1 (total 4 treatments three weeks apart). My radiation followed and was completed by July1st (36 treatments). Two weeks after my lumpectomy on my right breast I developed severe swelling of the right breast with redness of the skin and my surgeon called it a seroma. The surgeon attempted to aspirate it, but decided to send me to the Breast Cancer Center to have it drained under ultrasound. Consequently, they drained almost 600cc the first time! Unfortunatley, the fluid recurred and they recommended drainage again. The surgeon would put me on antibiotics, then send me to the Breast Center for drainage of the seroma. After three episodes of draining the right breast, the surgeon sent me to an Infectious Disease Dr who had no further suggestions or comments. I still continue to have swelling, considerable amount and resulting pain constantly. When I saw the surgeon in August she said I have lymphedema and basically will have to live with it. So, my question is, are seromas common after a simple lumpectomy and why do they occur? And now they are saying it is lymphedema. What is the difference between lymphedema and seroma, the causes, and the treatment? I do not have any swelling in my right arm at all and never have had, so I did not think it was ever lymphedema, from what I had read about lymphedema affecting the upper arm. Just my right breast is larger, swollen, harder and firmer to touch and painful. It is quite noticeable with some sweaters and definitely with an evening gown. Is there anything that can be done for the swelling and the pain? Should the surgeon be able to help me with this problem?

Answer

Susan, I'm so sorry you're having such troubles! While a seroma and lymphedema involve the same lymph (or serous) fluid, they're somewhat different issues. A seroma develops at the site of the wound - the lumpectomy - as the fluid collects in the area where the tumor was removed, basically filling a now-empty space. As it continues to collect, it makes your breast swell. Why does it collect? Because your lymph nodes wereremoved or damaged, and fluid is leaking from a number of damaged "node connectors" into your breast. Lymphedema, on the other hand, can affect your whole upper quadrant - arm, chest, and back. It, too, is the result of lymph node removal or damage; the lymph system is damaged enough that it just isn't as efficient at moving fluid around as it used to be, and there's a general swelling.

What to do? Can be very problematic, as you've seen. I hate to see them all give up on you; I'd get another opinion. I've heard of women who had chronic seromas, where the solution was an open drain with concurrent heavy antibiotics to ward off infection, until the area finally stops draining. At any rate, even lymphedema is treatable, so I don't think you're getting the best advice. I'd ask your PCP or hospital social worker how to go about getting some help; there's no way you should just accept this as a permanent state, OK? Good luck, and I hope you find some help soon - PJH

Answered by PJ Hamel