Be Our Partner! Book a Free Consultation Now! Become a Member > Get Involved >
Health Conditions > Health Articles > Find a Practitioner > Events >

Home  /  Health Conditions  /  Lymphedema

Lymphedema

Long-lasting swelling, most often in an arm or leg, caused by lymph fluid that can’t drain properly — often after cancer surgery or radiation that removed or damaged lymph nodes. It can’t be cured, but it is easier to control when treatment starts early, and good skin care helps prevent cellulitis, its most common complication.

Call 911 if you have chest pain or shortness of breath — especially with a painful, swollen arm or leg. A blood clot may have travelled to your lungs (a pulmonary embolism), which can be life-threatening and needs treatment straight away (NHS, CDC). Don’t drive yourself (NHS).

Get care urgently — the same day, from your doctor, urgent care or the ER — if:

Call your doctor soon if you notice new heaviness, tightness or swelling after cancer treatment. Lymphedema is easier to control when treatment starts early (National Cancer Institute).

What is lymphedema?

Lymphedema is swelling caused by a build-up of lymph — a fluid that carries infection-fighting white blood cells — when the lymph system is damaged or blocked (MedlinePlus). It can affect any part of the body but usually develops in the arms or legs (NHS). Once it develops it is long-term: it can’t be cured, but it can be treated to relieve swelling and help you function day to day (National Cancer Institute, NHS).

Primary and secondary lymphedema

Primary lymphedema is rare. It is caused by changes in genes that affect how the lymph system develops, often runs in families, and usually begins in infancy, the teenage years or early adulthood (NHS, NHS). One example, Milroy disease, usually causes swelling of the lower legs and feet at birth or in infancy (MedlinePlus Genetics).

Secondary lymphedema is much more common. It happens when a lymph system that used to work normally is damaged (NHS, NHS):

  • Cancer and its treatment. A tumor can block lymph flow, surgery can disrupt it, and radiation can leave scar tissue that blocks it. It may appear soon after treatment or years later, usually developing slowly (National Cancer Institute).
  • Infection: severe cellulitis can scar the lymph system. Worldwide, a common cause is lymphatic filariasis, a parasitic worm infection spread by insect bites in tropical regions (NHS, CDC).
  • Vein problems such as DVT and varicose veins, which can overload the lymph system; and obesity, injury, or long periods of not moving (NHS). See our Circulation guide.

Lymphedema after breast cancer

Breast cancer surgery often removes lymph nodes in the armpit, raising the risk of lymphedema in the hand, arm or chest on that side (National Cancer Institute). A review summarized by NCI’s expert board found lymphedema in about 21% of people treated for breast cancer — more often after a full armpit lymph node removal (axillary dissection) than after a sentinel lymph node biopsy, which removes fewer nodes (19.9% vs. 5.6%). More nodes removed, mastectomy, radiation to the lymph nodes, and overweight or obesity also raised the risk (NCI PDQ).

Gynecologic, prostate, colorectal, head and neck cancers, melanoma and sarcoma can also lead to lymphedema — in the leg, genitals or abdomen, or in the face and neck (National Cancer Institute). See our Cancer guide for support during and after treatment.

Symptoms

Symptoms can develop slowly, so watch for small changes (National Cancer Institute):

Stages

Clinicians describe how advanced lymphedema is using the International Society of Lymphology stages (NCI PDQ, National Cancer Institute):

  • Stage 0: lymph isn’t flowing as it should, with or without symptoms.
  • Stage I: swelling and heaviness; pressing leaves a dent (“pitting”). Resting and raising the limb bring the swelling down.
  • Stage II: more swelling and firmer tissue; pressing no longer leaves a dent, and raising the limb no longer helps.
  • Stage III: severe swelling with hard, thick skin, mostly from fat build-up rather than fluid.

How is it diagnosed?

Usually from your symptoms, history and an exam that measures the limb and compares it with the other side (NHS, National Cancer Institute). Bioimpedance, which uses a tiny, painless electrical current to detect extra fluid, can pick up early lymphedema before symptoms appear; imaging such as lymphoscintigraphy, MRI, CT or ultrasound may be used if the diagnosis is uncertain (National Cancer Institute, NHS). Other causes of a swollen limb, including a blood clot, cancer and infection, should be ruled out (NCI PDQ). If you are at risk after cancer treatment, ask whether you will be monitored for early signs (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Complete decongestive therapy with a certified lymphedema therapist: manual lymphatic drainage, compression bandaging, exercise and skin care, then daily compression garments. Pneumatic compression pumps for some people; surgery (lymphovenous bypass, lymph node transfer, liposuction) for selected cases. Medicare Part B now covers compression garments for lymphedema. Medicare Part B: 20% of the approved amount after the deductible for covered compression items. Other costs being researched. Not a cure, but swelling can usually be brought down and kept under control. Garments are worn long term; earlier treatment works better.
Chiropractic No role in treating lymphedema. We found little research on chiropractic care for it. Not a treatment for lymphedema, so no cost is listed. If you see a chiropractor for another reason, tell them about your lymphedema and avoid pressure on the affected limb.
Acupuncture Studied for arm lymphedema after breast cancer. Small Memorial Sloan Kettering pilot studies found it safe; a later randomized trial found it safe but no better than usual care at reducing swelling. About $90–$185 per follow-up visit at private clinics; community clinics about $50–$90. Not a substitute for compression and lymphedema therapy. Views differ on needling an affected limb — ask your lymphedema team first.
Herbal medicine No herb or supplement is approved for lymphedema. Coumarin didn’t work in a large trial and affected the liver in some women; evidence for selenium is limited. Cost estimate being researched. Don’t expect less swelling. Supplements can interact with medicines and some may interfere with cancer treatment — check with your care team.
Massage therapy Manual lymphatic drainage (MLD) — a gentle, specialized technique given by a trained lymphedema therapist — is part of standard treatment. General or deep massage on a swollen limb is not advised. Cost estimate being researched. Ask whether therapy is billed as physical therapy. MLD is safe and may add a little to compression bandaging, especially for milder lymphedema. You’ll be taught simple self-massage for home.
MBHA Wellness Coach Daily skin and nail care, avoiding cuts, burns and insect bites, wearing garments as advised, building up exercise (including supervised weight training), weight management, travel planning and emotional support. Cost estimate being researched. Good habits lower the chance of lymphedema worsening and of infection. They work alongside your lymphedema therapist, not instead of treatment.

Approach 1 of 6

Conventional medicine (AMA)

Treatment is usually led by a certified lymphedema therapist (CLT) — a physical or occupational therapist trained to treat lymphedema — or a nurse (National Cancer Institute).

1. Complete decongestive therapy (CDT)

CDT is the standard of care for stage II lymphedema (NCI PDQ). It has four parts: manual lymphatic drainage (a gentle, specialized massage), compression bandaging, exercises that use the muscles to move lymph, and skin care to prevent infection (NHS, National Cancer Institute). It comes in two phases (NCI PDQ, NHS):

  • Reduction phase: intensive, often daily treatment for several weeks to bring the swelling down.
  • Maintenance phase: you take over, with compression garments, simple self-massage, exercise and skin care, plus check-ups every few months.

It takes time and effort, but it can bring lymphedema under control (NHS).

2. Compression garments and bandages

Sleeves, gloves, stockings, bandages or Velcro wraps work with your muscles to push fluid out of the limb; your therapist will fit them and teach you to put them on (NHS, National Cancer Institute). Firmer flat-knit garments work better than stretchier ones for stage II and III lymphedema (NCI PDQ). Compression isn’t suitable for everyone — for example, people with artery problems in their legs (NHS).

3. Pneumatic compression pumps

A pump attached to a sleeve or stocking inflates and deflates to keep lymph moving (National Cancer Institute). It should be used with compression garments, and only when garments alone aren’t enough (NCI PDQ).

4. Surgery, for selected people

Non-surgical treatment should be tried first (NCI PDQ). For advanced lymphedema, options include lymphovenous bypass, which connects lymph vessels to a vein; vascularized lymph node transfer, which moves healthy lymph nodes from elsewhere in the body; and liposuction to remove the fat that builds up in long-standing lymphedema (National Cancer Institute, NHS). Bypass is usually used for earlier-stage lymphedema, lymph node transfer results are promising but limited, and after liposuction you need a compression garment for life (NCI PDQ, NHS). These operations are offered at specialist centers (NHS).

5. Medicines

No medicine has been approved to treat lymphedema, and a 2022 review found the evidence for drug treatments too weak to recommend any (Walker et al., 2022). Antibiotics treat cellulitis when it happens (National Cancer Institute).

Medicare coverage of compression garments

Since January 1, 2024, under Section 4133 of the Consolidated Appropriations Act, 2023, Medicare Part B covers lymphedema compression treatment items (CMS). These include standard and custom-fitted gradient compression garments, gradient compression wraps and compression bandaging supplies. Your doctor or other provider must order them, and after the Part B deductible you pay 20% of the Medicare-approved amount (Medicare.gov). Medicare generally replaces up to three daytime garments or wraps per affected body part every 6 months and two nighttime garments every 2 years, and items must come from an enrolled supplier (CMS). Part B also covers medically necessary outpatient physical therapy that your provider certifies (Medicare.gov).

What it costs

Beyond the Medicare share above, MBHA cost estimate being researched (lymphedema therapy sessions, garments without insurance, pumps and surgery).

How well it works — what to expect

There’s no cure, but the main symptoms can usually be controlled, and keeping to your plan makes them less noticeable over time (NHS). In one Cochrane review, people whose swelling had been brought down were likely to keep it down if they kept wearing a custom-made sleeve (Cochrane review, 2015).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating lymphedema, and we found little research on it. The treatments with evidence behind them — compression, specialized lymphatic drainage, exercise and skin care — are described under Conventional medicine.

If you see a chiropractor for another problem, such as back or neck pain, tell them you have lymphedema or are at risk of it. NCI advises avoiding pressure on an affected area (National Cancer Institute), so ask them to avoid firm pressure on the swollen limb, and never let any treatment delay care for the warning signs at the top of this page.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

What the studies found

Researchers at Memorial Sloan Kettering Cancer Center (MSK) have studied acupuncture for arm lymphedema after breast cancer:

  • 2011 pilot (9 women): four had at least a 30% reduction in the extra size of the affected arm after 4 weeks, and there were no serious side effects in 73 sessions. The authors noted that needling the affected arm had traditionally been prohibited (Cassileth et al., 2011).
  • 2013 pilot (33 women evaluated): 11 (33%) had at least a 30% reduction. Some had minor bruising, pain or tingling, but there were no serious side effects, infections or severe flare-ups over 255 sessions and 6 months of follow-up. The authors judged acupuncture safe but said the results needed confirming in a randomized trial (Cassileth et al., 2013).
  • 2018 randomized trial (82 women): acupuncture was again safe, but it did not reduce arm swelling significantly more than usual care in women also getting standard lymphedema treatment (Bao et al., 2018).

Safety views are mixed

The MSK studies found no serious harms, but other advice still urges caution with needles in an affected limb: the NHS, for example, recommends not having injections in the affected area whenever possible (NHS). If you want to try acupuncture, talk with your lymphedema team first, and ask whether needles should avoid the affected limb. Choose a licensed practitioner who uses sterile, single-use needles: problems with acupuncture are rare when it is done properly, but improper treatment can cause infections and other serious harm (NCCIH). Clean-needle practice matters even more if your immune system is weakened by cancer treatment (NCCIH). Don’t have acupuncture near skin that is red, hot or infected.

What it costs

Private follow-up visits run about $90–$185 in recent published examples, and community acupuncture about $50–$90 per visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement is approved to treat lymphedema. A 2022 review of trials of medicines and other treatments, including selenium, found the evidence insufficient for any of them (Walker et al., 2022). Talk with your care team before taking anything, especially if you are still being treated for cancer — some herbs may make chemotherapy less effective (NCCIH).

Coumarin (benzopyrones)

Coumarin had been reported to help lymphedema, so a trial led by Mayo Clinic researchers tested it in 140 women with arm lymphedema after breast cancer. Arm swelling was virtually the same on coumarin and on a dummy pill, and coumarin showed signs of liver toxicity on blood tests in 6% of the women. The researchers concluded that it is not effective for this kind of lymphedema (Loprinzi et al., 1999). Some other benzopyrone trials have reported benefits, but earlier analyses have cast doubt on them (Walker et al., 2022).

Selenium

A Cochrane review found only one small trial of selenium for lymphedema linked to cancer treatment. It reported fewer repeat skin infections (erysipelas) with selenium, but the trial had weaknesses, and the reviewers concluded there isn’t enough evidence that selenium reduces lymphedema. They also cautioned that supplementing a trace mineral has potential hazards (Cochrane review, 2006).

Interactions

Supplements can interact with medicines, and some can raise bleeding risk or affect anesthesia if you are having surgery (NCCIH) — something to keep in mind if you are considering lymphedema surgery. Tell every clinician about everything you take. We don’t list doses here.

Approach 5 of 6

Massage therapy

Two very different things are called “massage.” Manual lymphatic drainage (MLD), given by a trained lymphedema therapist, is part of standard treatment. General massage on a swollen limb is not advised: Cancer Research UK says to avoid general massage therapy on arms or legs swollen by lymphedema, and explains that people who need MLD are referred to a lymphedema specialist (Cancer Research UK).

Manual lymphatic drainage (MLD)

MLD is a gentle massage that helps move lymph fluid out of a swollen area toward lymph nodes that work (National Cancer Institute, NHS). It is one part of complete decongestive therapy, alongside compression, exercise and skin care, managed by a certified lymphedema therapist (National Cancer Institute). Your therapist will also teach you, or a family member, simpler self-massage techniques (simple lymphatic drainage) to use at home (NHS, National Cancer Institute).

What the evidence shows

  • A 2015 Cochrane review of six small trials in breast cancer–related lymphedema found MLD safe in every trial. Added to compression bandaging, it gave an extra reduction in swelling of about 7 percentage points, mainly in milder lymphedema. Other comparisons were inconsistent, and 60%–80% of people felt less pain and heaviness whichever treatment they had (Cochrane review, 2015).
  • A review summarized by NCI’s expert board found that MLD might lower the chance of developing lymphedema after breast cancer in some studies, but most studies showed no difference in arm volume; it did help with pain (NCI PDQ).

Staying safe

What it costs

MBHA cost estimate being researched. Many certified lymphedema therapists are physical or occupational therapists (National Cancer Institute), and Medicare Part B covers medically necessary outpatient physical therapy that your provider certifies (Medicare.gov) — ask how your sessions will be billed.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the daily habits your lymphedema therapist recommends and keep them going.

Skin and nail care

Preventing cuts and bites

Exercise — including weight training

Exercise acts as a natural pump for the lymph system (National Cancer Institute), and early fears that it would make lymphedema worse have not been confirmed (NCI PDQ). The Physical Activity and Lymphedema (PAL) trials changed advice about lifting weights:

  • In 141 breast cancer survivors with lymphedema, twice-weekly, slowly progressive weight lifting — while wearing a well-fitted compression garment — did not increase swelling, and it led to fewer flare-ups (14% vs. 29%), fewer symptoms and more strength (Schmitz et al., 2009).
  • In 154 survivors at risk of lymphedema, a year of slowly progressive weight lifting did not increase the chance of developing it (Schmitz et al., 2010).

A supervised, progressive strength program is considered safe after breast cancer, but there isn’t enough data on unsupervised exercise or other cancers (NCI PDQ). Start with your therapist’s guidance, build up slowly, and add walking, swimming or cycling (NHS).

Weight, garments and daily habits

Travel

In a large study of people treated for breast cancer, the number and length of flights were not linked to arm swelling (Ferguson et al., 2016), though the evidence overall is limited (Asdourian et al., 2016). Ask your therapist whether to wear your garment while travelling. On trips longer than 4 hours, walk around every 1 to 2 hours and exercise your legs while sitting to lower the risk of blood clots (CDC).

Emotional support

Lymphedema can change how you look and what you can wear or do, and leave you feeling isolated (National Cancer Institute). Talking with others who have it can ease stress and anxiety; if you have felt down for months, talk to your doctor — depression is treatable (NHS). A coach is never a substitute for medical care.

Another approach

Lowering your risk after breast cancer surgery

There is no sure way to prevent lymphedema, but you can lower your risk and keep it from getting worse (National Cancer Institute, NHS). Steps with some evidence behind them:

Blood pressure cuffs and needle sticks: what the evidence shows

NCI advises using the arm without lymphedema for blood pressure and blood draws (National Cancer Institute), and the NHS advises avoiding injections and blood pressure readings in the affected area whenever possible (NHS). The research behind these precautions, though, is uncertain:

  • A 2016 review of 31 studies found that the precautions are not backed by high-level evidence; most studies gave low-level or inconclusive results. Skin infections and previous infection or inflammation in the arm were the most clearly established risk factors (Asdourian et al., 2016).
  • A Massachusetts General Hospital study that tracked arm volume in people treated for breast cancer (3,041 measurements) found no link between arm swelling and blood draws, injections or air travel, and concluded that blood pressure readings may not be linked either. Being overweight, axillary dissection, lymph node radiation and cellulitis were linked to swelling (Ferguson et al., 2016).

Using your other arm when it’s easy costs nothing, but if a needle or cuff on the at-risk arm is needed, current research has not shown that it causes lymphedema. Talk it through with your care team.

Another approach

Lymphedema and cellulitis

Cellulitis is the most common complication of lymphedema (NHS). Swollen skin is stretched thin, which lets bacteria in more easily, and the bacteria thrive in the fluid-rich tissue (National Cancer Institute). It works the other way too: severe cellulitis can scar the lymph system and cause lymphedema (NHS), and in a large breast cancer study cellulitis was linked to increases in arm swelling (Ferguson et al., 2016).

Know the signs: pain, tenderness, redness and more swelling; skin that feels warm; and fever, or feeling hot, cold or shivery. Redness can be harder to see on brown or black skin (National Cancer Institute, NHS). Call your doctor right away — cellulitis is treated with antibiotics and can become life-threatening if it isn’t (National Cancer Institute). Raising the limb can help the swelling go down and speed recovery (CDC).

The daily skin care in Wellness coaching above helps protect you. Our Cellulitis guide covers the infection in detail, including what to do when it keeps coming back.

Another approach

Lipedema or lymphedema?

Lipedema (lipoedema in the UK) is another cause of large legs: an abnormal build-up of fat in the bottom, thighs and lower legs, and sometimes the arms. It is more common in women, usually affects both sides equally, typically spares the feet and hands, and can be painful, tender and bruise easily (NHS). Lymphedema, by contrast, is swelling from fluid that often involves the hand or foot and is frequently on one side only (NCI PDQ, NHS).

Lipedema is not caused by being overweight. There is no cure, but healthy eating and exercise, compression, skin care, counselling and, for severe cases, liposuction can help (NHS). If your legs are large or swollen, see a doctor to find out which condition you have — and get urgent care if they become red, hot and painful with flu-like symptoms (NHS).

Member stories

Living with Lymphedema? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

No stories have been published for this condition yet. Yours could be the first.

Which approaches have you tried?

What did you try, what did it cost, and what changed for you? Please leave out anything you’d rather keep private.

We read every story before it’s published and may shorten it. Stories describe one person’s experience; results vary. See our Privacy Policy.

Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

Find the right practitioner

Search MBHA’s Health Directory for doctors, chiropractors, acupuncturists and massage therapists across the Monterey Bay.

Search the Directory All Health Conditions

The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)(3) organization and does not endorse any particular products or practices. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. We strongly recommend that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition. MBHA provides administrative support, education and navigation — not medical, legal or tax advice — and cannot guarantee claim, billing or fundraising outcomes. MBHA is not an emergency service: in an emergency, call 911 or go to the nearest emergency room.