Removing or irradiating the lymph nodes in the armpit during breast cancer treatment can leave the arm unable to drain lymph, so protein-rich fluid collects in the tissues. The swelling can start months or years after surgery and is usually lifelong, but early care keeps it under control.
Key symptoms
- Swelling of the arm, hand or chest wall on the surgery side
- Feeling of heaviness, tightness or fullness
- Rings, watch or sleeves feeling tight
- Aching and reduced movement of the arm
What you find on exam
- Compare arm circumference at set points on both sides
- Pitting edema early, firm thickened skin later
- Skin for redness, warmth, cracks or infection
- Shoulder range of motion and hand function
Tests
- Mainly a clinical diagnosis with repeated limb measurements
- Bioimpedance or limb volume measurement to detect early change
- Duplex ultrasound for sudden swelling to rule out a blood clot
- Look for cancer recurrence if new swelling comes with pain or a mass
Treatment basics
- Complete decongestive therapy: manual lymph drainage, multilayer bandaging and exercise
- Fitted compression sleeve worn during the day
- Daily skin care and prompt treatment of small cuts
- Weight control and gradual strength exercise
- Antibiotics such as cephalexin for cellulitis; surgery in selected cases
Red flags
- Red, hot, painful arm with fever (cellulitis)
- Sudden painful swelling suggesting a blood clot
- New hard mass, skin change or nerve pain suggesting recurrence
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.