We should at first stage the lymphedema. http://www.breastcancer.org/treatment/lymphedema/how/stages
For the purpose of discussion we shall assume it to be severe. Severe Lymphedema needs to be managed by Compression and reduction in the form of Lymphapress and stockings. Strengthening of limb muscles along with lymphedema exercises that help drain and mobilise lymphedema are important. Finally skin and nail care to keep them clean and moist is important. The above are done in coordination with Physiotherapy department and clinicians.
In this case we are talking about secondary lymphedema, following mastectomy, radiation therapy and potentially SLND/ALND. Depending on the timecourse since the initial therapy there are several factors to discuss: how long has the lymphedema been there? Has there been a course of conservative treatment with compression garments? Is there scarring in the axilla with fibrosis following irradiation and/or radiodermatitis and/or ALND?
Exact diagnosis and workup is mandatory including appropriate staging. Lymphography, microlymphography and MRI angiography can help. Contralateral measurements may be useful and a precise follow-up is necessary.
Conservative compression therapy is the standard of care, supported by manual lymphatic drainage therapy. I agree that physiotherapy is supportive. However conservative therapy is time consuming, shows only slow progress in most cases and low compliance of the patients side in many cases.
Surgical therapy most recently has proven to be effective in selected cases after failure of conservative therapy. Several strategies such as lymphatic reconstruction (Baumeister R, Munich, Germany), lympho-venous microanastomosis (Campisi C, Genua, Italy), autologous free microvascular lymphnode-transfer and free flap techniques including lymphnode packages (Becker C, Paris, France; Saaristo A, Turku, Finland; Cheng MH, Chang Gung, Taiwan) have shown their efficacy. In cases refractory to conservative treament liposuction (Brorson H, Malmö, Sweden) has shown some effect, if there was a increase of subcutaneous fat. This has to differentiated from lipedema, which however can be treated with liposuction as well.
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