Lymphoedema develops in the arm when the drainage of a fluid called lymph from the tissues in the arm is impaired, causing the lymph fluid to accumulate in those tissues, which makes the arm swell. The lymph drainage, through the lymph glands under the arm, can be affected either by removal of glands at operation or sometimes by scarring, caused by radiotherapy or surgery, or by the presence of tumour in the glands.

Once the lymph drainage has been damaged it never completely goes back to normal so it is unusual to get rid of all traces of lymphoedema. But a variety of things can be done to help reduce and control the swelling. These include:

• good skin care: gently moisturising the skin each day with a non-perfumed cream or oil and avoiding any risk of infections in the arm (from cuts, burns etc).
• compression garments: these are stretchy sleeves which gently squeeze the swollen tissues, preventing fluid from building up and giving the muscles support. They do need to be expertly measured and fitted. Sometimes if there is a lot of swelling special multi-layered bandages will be used at first, to reduce the swelling sufficiently for a sleeve to be fitted.
• limb positioning: gravity affects the amount of swelling in the arm. If you can keep your arm up on a cushion when sitting down, or slightly elevated on a pillow in bed at night this will help. Also avoid carrying heavy shopping or other loads with your affected arm.
• exercises: gentle exercises will help your muscles to work with the compression sleeve to move fluid out of the arm. massage: Manual lymphatic drainage (MLD) is very gentle form of massage which aims to encourage movement of lymph away from swollen areas. As this is a specialised form of massage, it should be given only by a trained therapist. Increasingly, MLD is provided by the NHS at lymphoedema treatment clinics. However, it is not yet available at all centers. Simple lymphatic drainage (SLD) is a simplified form of MLD that you can do at home once you have been taught the techniques by a specialist. Hand-held massagers may be useful for people who have restricted movement of their hands, perhaps due to arthritis. However, it is a good idea to talk to your lymphoedema therapist before buying a massager.
• compression pumps: these are only occasionally used and are electrically powered to gently squeeze the arm and help to move the fluid in those people whose lymphoedema is caused by tumour in their lymph glands then further treatment with chemotherapy or hormones may well help to ease the problem.

As you can see, although a lot can be done the treatment of lymphoedema needs special skills and expert help. In most hospitals that treat breast cancer either the Breast Care Nurses are trained to give advice or, often there are special Lymphoedema Clinics with specialist practitioners who specialise in managing the problem. So do have a word with your local breast cancer team and they will ensure you get to see the right person to help you.