Breast cancer is one of the most common cancers among women in Hong Kong. Although advances in treatment have enabled most patients to be diagnosed early, post-surgical lymphoedema often poses a major challenge during recovery. It not only affects upper limb function but can also bring physical and mental stress, hindering work and daily life. Understanding the causes, symptoms and management of lymphoedema helps patients better navigate the recovery journey.
Current Situation of Breast Cancer in Hong Kong and Importance of Early Diagnosis
Breast cancer is the most common cancer in Hong Kong women. Statistics indicate that one in every 13 women may develop it in her lifetime. In 2023, 834 women died from breast cancer, accounting for 13.1% of all female cancer deaths. Fortunately, Hospital Authority data shows that over 80% of patients are diagnosed at early stages (first to third stage). The earlier the diagnosis, the higher the survival rate: 99.3% for stage I, 94.6% for stage II, 76.2% for stage III, and 29.8% for stage IV.
Clinical oncologist Dr. Lee Wai-man Sarah (李慧敏醫生) points out that early detection and appropriate treatment can significantly improve recovery chances. Surgery is one of the main treatment options for breast cancer, primarily divided into breast-conserving surgery and total mastectomy. Breast-conserving surgery removes the tumour and surrounding tissue while preserving most of the breast structure; total mastectomy is suitable for patients with larger tumours or multiple lesions. After surgery, besides monitoring recurrence risk, post-operative functional rehabilitation and lifestyle management are equally crucial.
Causes and Risks of Post-Surgical Lymphoedema
Clinically, about 80% of breast cancer patients undergo axillary lymph node removal during surgery, a high-risk factor for lymphoedema. Studies show that approximately 20% of patients develop arm lymphoedema after breast surgery or radiotherapy, with symptoms possibly appearing months or even years later.
Dr. Lee Wai-man Sarah explains that lymphoedema is chronic swelling caused by damage to the lymphatic system. Normally, lymph fluid clears metabolic waste, but when lymph vessels are damaged or blocked, fluid retention leads to abnormal swelling. Common sites include the arm, hand, breast and axilla, and it may also affect the chest or head and neck. Patients often experience tight, red, stiff or tender skin, arm heaviness or tingling. Some have restricted shoulder or wrist movement, with less visible hand veins and tendons, significantly impacting daily activities.
Since breast and upper limb lymph mainly drains to the axillary nodes, surgical removal or biopsy disrupts the "main drainage trunk". Additional radiotherapy to the axilla or supraclavicular area can cause fibrosis and hardening, further blocking flow. With longer survival rates for breast cancer patients, lymphoedema can develop gradually and persistently affect quality of life.
Impact of Lymphoedema on Physical, Mental Health and Work
Lymphoedema is not just "swollen hands" but a comprehensive decline in upper limb function. Patients frequently suffer pain, stiffness and heaviness, making dressing, typing, lifting and housework difficult. According to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, lymphoedema patients score on average 23.4 points higher than asymptomatic women, indicating clear functional impairment.
Psychologically, the proportion of lymphoedema patients using antidepressants after mastectomy increases significantly. Studies show SSRI usage at 12.6% (vs 8.2% in controls) and SNRI at 14% (vs 7.3%). Visible changes and repeated questioning about the condition cause anxiety, lowered self-esteem, affecting work performance and social life. Some patients need to adjust job nature to lighter duties or switch from full-time to part-time.
Effective Management of Lymphoedema to Regain Confidence
Treatment aims to reduce swelling, maintain lymph flow and prevent recurrence. Dr. Lee Wai-man Sarah notes common clinical methods include wearing elastic garments like sleeves to reduce swelling, short-stretch bandaging by professionals, moderate exercise and manual lymphatic drainage (MLD) to promote circulation.
In daily life, patients should avoid heavy lifting or excessive repetitive movements, prevent cuts or abrasions to lower infection risk, avoid high-temperature activities like sunbathing, hot baths or saunas, maintain healthy weight, and elevate the arm slightly on a pillow during sleep (not above shoulder level). Dr. Lee reminds that treatment takes time; patients must be patient and persistent with rehabilitation. Seek immediate medical attention for arm swelling or discomfort to prevent permanent tissue changes such as thickening and fibrosis.
Breast cancer recovery goes beyond fighting cancer; managing post-surgical lymphoedema is essential. With professional guidance and proactive lifestyle adjustments, patients can effectively relieve symptoms and regain physical and mental health. If patients have any concerns or experience any discomfort during their recovery, they should proactively communicate with their attending physician to obtain appropriate advice.
More information about breast cancer treatments: Early Breast Cancer Signs & Causes | OncoCare
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Post-Surgical Lymphoedema Frequently Asked Questions
Q1: What is the main cause of post-breast cancer surgery lymphoedema?
A: Primarily due to surgical removal of axillary lymph nodes or radiotherapy damaging the lymphatic system, preventing normal lymph fluid drainage.
Q2: What are the common symptoms of lymphoedema?
A: Tight, red, stiff or painful skin, arm heaviness or tingling, restricted joint movement, etc.
Q3: How to effectively treat and manage lymphoedema?
A: Wear elastic sleeves, receive bandaging, manual lymphatic drainage and moderate exercise; avoid heavy objects and high-temperature activities in daily life.
Q4: Does lymphoedema affect mental health?
A: Yes, patients have a higher rate of antidepressant use; pay attention to emotional changes and seek support.
Q5: What should patients do if needed?
A: Patients in need may consult their attending clinical oncologist for appropriate advice.
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