Truncal Lymphedema

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Truncal lymphedema is the pain and/or swelling of the breast, chest, back and underarm area due to the buildup of lymphatic fluid. It often presents differently than arm edema because besides the fullness, heaviness, or discomfort you feel when you have arm lymphedema, with breast lymphedema you can also have varying degrees of pain, from mild to severe. Pain may even be the first symptom before the swelling is obvious.

Truncal lymphedema is often misdiagnosed or undiagnosed, and patients with excessive fullness and/or pain in the breast, chest, lateral trunk, armpit or back are living with post-treatment discomfort. In response to the many requests Bellisse has received for more information about truncal lymphedema signs and symptoms, we have created this page. The images and descriptions below will give you an idea of how this problem may present or what it may look like – of course you should always consult with your doctor or lymphedema therapist to be sure.

Truncal lymphedema is common following breast cancer surgery, but can also occur after treatment for lung cancer (lobectomy and radiation). Complete Decongestive Therapy in conjunction with compression therapy is the standard treatment for truncal lymphedema around the world.

Post treatment edema can last for weeks or even months after surgical procedures such as breast reduction and augmentation, and could often be more comfortably managed wit

 

h a bra that provides comfortable compression, that is adjustable circumferentially, and that has cups that can conform to the shape of the healing tissue.


Truncal Lymphedema Following Breast Cancer Surgery:

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The patient pictured here is two years out of breast cancer treatment. She had a lumpectomy with radiation to the lateral side of her left breast.

Note the lines from her bra on the front of the left breast – and note that there are no lines on the untreated right breast. Since this patient had surgery or radiation treatment more than a month ago, this is not normal. It indicates thickening of the fluid in the skin, creating a play-dough consistency (pitting edema) of the skin. For some patients this condition is very painful; for others it is full and uncomfortable. It has been described by some patients as a “migraine in the chest”.

Lymphedema occurs in the back as well: note the increased fullness of the area around the bra strap and the deeper indentation on the left compared to the right. Also note the increased fullness between the waist fold and the bra’s strap. The entire quadrant (upper back, side, chest and arm) can be affected, and is at risk when the lymph nodes in the armpit are removed (including sentinel node biopsy) and/or the chest wall /breasts are treated with surgery or radiation.


Truncal Lymphedema Following Breast Reconstruction

Acute - 3 weeks

Lymphedema can happen in the reconstruction population, and can be acute (lasting 9 to 12 weeks – Picture A) or chronic (lasting more than 9 weeks – Picture B)


Patient B, on the right, had a tram flap about one year ago. Note the pinkish discoloration of the left breast and the excessive fullness compared to the right. This patient also has abdominal edema above and below the scar.

Chronic - 1 year after surgeryPatient A, on the left, had a tram flap three weeks ago and has breast edema. Compression and soft, conforming bra cups may greatly increase comfort as this heals.

The pinkish discoloration of the breasts of both patients could be misdiagnosed as an infection. There are even some extreme cases documented where chronic breast edema has been misdiagnosed as inflammatory breast cancer. Inflammation can aggravate acute post-surgical edema, which will also aggravate the lymphedema.


 

Post Radiation Edema/Lymphedema

altTruncal lymphedema can appear following radiation treatment. Radiation fibrosis, which is thickening of the skin and a common side effect of radiation treatment, may be present for months after treatment is finished. There can also be pain that persists in the area of radiation months after the radiation is finished. Traditional bras may cut and bind sensitive tissues as they are healing, and the Torso Compressure Comfort Garment may provide the gentle support and soft cups that allow a patient to be more comfortable in her activities of daily living. If the thickness and leathery feeling persist, a consultation with a physician and a lymphedema therapist might be in order. Often this post-radiation scarring can be treated with Complete Decongestive Therapy, compression, and the use of chip pads to greatly improve the suppleness and softness of the skin.
 


Asymmetry

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Asymmetry may be common after breast cancer treatment, it may be from surgery or from lymphedema. This patient has asymmetry after surgery and has lymphedema

In the picture on the left, note the marked asymmetry of the right breast after breast cancer treatment. This patient has truncal lymphedema, including a "peau d'orange" look to the skin, which means that the skin has become bumpy, shiny, and thick (like the skin of an orange). The skin can also be very tender.

3 weeks post-opThe Torso Compressure Comfort® Garment will accommodate the difference in breast size and shape and support these swollen and painful tissues. Complete decongestive therapy and proper compression will help decrease the swelling and the pain that the patient probably feels.
 

   

8 months post-opThese two pictures show asymmetry following a tram flap reconstruction of the left breast. Note the bruising and overall tension/tightness of the skin, and the inflammation/soreness around the surgical incisions. The reconstructed breast is very fibrotic, i.e. hard in texture. It may not fit well into a bra for a few months after surgery and may be very tender while it is healing.  The end cosmetic result is lovely. However, during the healing process a Torso Compressure Comfort Garment would provide support to the breast asymmetry and support the variance in breast position. Patients also wear the Torso Compressure Comfort Garment at night to support swollen and healing tissue.


Fullness in the Armpits

altSometimes patients get fullness in the armpits after treatment for breast cancer. This can be one of the symptoms of truncal lymphedema. There are products available (i.e. "chip pads" (commercially-produced or made in the clinic) that will apply comfortable compression to the armpits, decreasing the fullness.

The patient pictured here had lung cancer on the left with marked radiation, which caused severe breast lymphedema in the right chest, breast, and armpit. She would sleep with the pads and the Torso Compressure Comfort Garment, decreasing the fullness in her chest and in her armpits and making daytime and nighttime more comfortable.


Trunk Fullness and Asymmetry

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This patient seen here wearing the Torso Compressure Comfort Garment has had a lumpectomy on the right side. The extra tissue at the bottom of the bra is her waist, not her breasts. Note the increased fullness on the right side in the front and the back compared to the left. This is a clear example of trunk fullness and asymmetry front and back.

Although it is not clearly visible in the pictures, this patient had a deep indentation on the right, where the right bra strap comes down the front of her upper chest wall. This was the result of her wearing a bra that was too small and too tight. After lymphedema treatment to her chest wall, and with use of the Torso Compressure Comfort Garment, the lymphedema in her right arm became easier to manage, and her trunk swelling went down dramatically. The straps of her old bra had been a kind of "tourniquet" around her front upper chest, and the tight bra band had had a similar effect around her midsection. When she stopped wearing her old bra and switched to the Torso Compressure Comfort Garment, drainage of fluid became much easier and she was much more comfortable.


 

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