Division of Cardiovascular Medicine
The Division of Cardiovascular Medicine provides high-quality heart health services, vast research opportunities, and comprehensive education and training programs.
Lymphedema Care
Personalized care for swelling caused by lymphatic system changes
Personalized Care for Lymphedema
Living with swelling can affect how you move, feel and go about your day. Lymphedema care at Lahey Clinic focuses on helping you manage symptoms, protect your skin and maintain mobility.
At our dedicated Lymphedema Center, you will receive care from doctors that treat lymphedema, as well as therapists and specialists who understand how this condition affects the whole body. Treatment plans are built around your needs and may include lymphedema therapy, physical therapy, compression care and, in some cases, surgery.
Understanding the Lymphatic System
The lymphatic system is part of your immune and circulatory systems. It helps move fluid through the body, remove waste and support immune function. When the lymphatic system is damaged or blocked, fluid can build up in nearby tissues and cause swelling.
What Is Lymphedema?
Lymphedema is a medical condition that may occur when regional lymph nodes are compromised due to surgery, radiation or injury, or if there is a congenital deformity within the lymphatic system. This results in an abnormal accumulation of fluid in the surrounding tissue and eventually in the entire limb. Lymphedema can be manifested in two ways:
Primary and Secondary Lymphedema
- Primary lymphedema is an inherited condition in which lymph nodes and/or lymph vessels are absent or abnormal. This condition can be present at birth, develop during puberty, or develop after age 35.
- Secondary lymphedema can be caused by damage to the lymphatic system. These compromises may be caused by infection, injury, cancer, scar tissue from radiation therapy, or the surgical removal of lymph nodes. Surgeries that may lead to the incidence of lymphedema could include but are not limited to surgeries for the treatment of breast, uterine/cervical, melanoma, prostate, and throat/mouth cancers.
People have a higher risk of secondary lymphedema after cancer treatment, especially following lymph node removal or radiation therapy for breast cancer. Infections and inflammatory conditions can also affect lymphatic flow.
Lahey Clinic's Lymphedema Center offers a multidisciplinary team approach for the evaluation and treatment of lymphedema. This team is comprised of the Vascular Medicine Department, Cancer Center, and Physical & Occupational Therapy Departments.
The Vascular Medicine Department includes specialists with expertise in vascular diseases, including lymphedema. Our Physical and Occupational Therapy departments include therapists who have completed specialized training to provide lymphedema care. These specialists are recognized as Certified Lymphedema Therapists (CLTs).
Diagnosis and Evaluation
Evaluation begins with a physical exam and a review of symptoms, medical history and prior treatments. Imaging tests may be used to better understand lymphatic flow and guide care planning.
More About Lymphedema Care
Lymphedema Therapy
Lymphedema therapy focuses on reducing swelling, improving movement and helping you manage symptoms long term. Treatment is provided in coordination with physical therapy.
What to Expect From Lymphedema Physical Therapy (PT)
Before therapy
- Evaluation of swelling, skin health and movement
- Review of daily activities and goals
During therapy
- Manual lymphatic drainage
- Compression therapy or bandaging
- Therapeutic exercises to support lymphatic flow
- Education on skin care and symptom management
After therapy
- Guidance on compression garments
- Home exercises and self-care strategies
- Ongoing support to help prevent flare-ups
Lymphedema Surgery
For some people, lymphedema surgery may be part of treatment. Surgical options aim to improve lymphatic drainage or reduce swelling when conservative care is not enough.
Evaluation and treatment planning may involve specialists from surgery, plastic and reconstructive surgery and vascular surgery. Some procedures use imaging-guided or minimally invasive techniques, including interventional options such as sclerotherapy when appropriate.
Lymphedema Treatment
Complete Decongestive Therapy (CDT)
There are various treatments for lymphedema. At Lahey, one method utilized is complete decongestive therapy (CDT). A patient can either be directly referred to physical or occupational therapy to receive CDT, or they may be seen first in Vascular Medicine for an evaluation and to rule out any vascular complications. If the patient sees Vascular Medicine for testing first, they can then be referred to physical therapy to determine the extent of therapy that is needed.
CDT is performed by a CLT and consists of many integral components. The first is manual lymph drainage (MLD), which utilizes specific techniques to assist in mobilizing fluid. The second component is compression bandaging of the affected limb(s) with specialized minimally elastic bandages. These are applied following MLD to further assist with decongestion of the limb. The patient wears the bandages continuously until their next treatment the following day. This process continues daily until sufficient decongestion is obtained. CDT is most effective when the combination of MLD and compression bandaging is performed.
When sufficient decongestion is obtained, the maintenance phase of therapy begins. The patient is fitted for a custom compression garment, which is worn daily. Compression garments may also be required nightly. The patient will also be instructed in a specific set of exercises to perform several times per week, and they will also perform daily skin care. This maintenance phase of compression, exercise, and skin care is necessary to ensure continued decongestion and reduce the risk of developing serious tissue infection such as cellulitis. Again, depending on the patient’s condition, the extent of compression will vary.
Please note that CDT is not a cure for lymphedema. It is, however, a treatment method that may allow a significant decrease in swelling, pain, discomfort and the risk of serious infection, while also increasing the patient’s mobility. Therapy is extremely effective in obtaining these goals, but lymphedema is a lifelong condition that requires a continued commitment to maintenance.
