How Much Compression Is Needed
to Effectively Manage
Truncal Lymphedema?
There have been no scientific studies about the appropriate amount of compression for truncal lymphedema, because no measurement system has been developed to assess the amount and quality of swelling in the trunk. All we can do right now is rely on practitioners’ ability to palpate and assess swelling and treatment needs for the trunk.
Treatment considerations for truncal lymphedema are very different than those for arm lymphedema. For example, the tissue around the chest wall is much less bulky and has much less muscle than the arm. The breasts themselves have no muscles at all to pump out fluid. Therefore the amount of compression needed on the breasts and trunk is far less than in the arm.
Another problem with determining the appropriate amount of compression for truncal edema is that swelling, pressure, and discomfort frequently fluctuate with heat, activity, and even with flying. The level of edema in the trunk is very sensitive to pressure changes, which is why adjustability (especially in milder cases) is a much needed - and much appreciated - element in truncal compression.
With no absolute measurements, many practitioners around the country are using patient comfort as an indication of appropriate compression for the trunk, and are getting excellent symptom amelioration and edema reduction. Practitioners tell of patients reducing as much as two cup sizes within a week or so while they are in active treatment that incorporates an appropriate compression garment. Patients are then able to maintain this improvement with independent treatment.
Sometimes the best guide is the patient’s mobility or degree of pain relief. Patients can feel when their movements are less restricted, and when linear pressure around the trunk has been reduced. This is very important, especially when we are trying to clear the UE through the affected chest wall, because it provides improved drainage for alternate lymphatic pathways.
An appropriate compression garment provides for all of these variables for the patient with truncal edema. Avoid using mastectomy and sports bras, which are not designed for truncal lymphedema. Instead, choose a bra that provides full coverage for the torso (i.e. a long silhouette on both front and back, with coverage high under the arms), and that has wide, padded straps for patient comfort, and a front zipper for easy donning. (For more information on appropriate compression for truncal lymphedema visit http://www.bellisse.com/comfort_bra/features.shtml.)
Lightning 2, LLC