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Lymphedema Care 

Lymph Node Removal and Lymphedema Risk

Lymphedema is a common concern after cancer treatment, especially when lymph nodes are removed or treated with radiation. The number of lymph nodes affected, type of surgery, and additional factors all influence risk.

 

Understanding these risks—and how compression garments can help—empowers patients and families to take early, preventive steps.

Why Lymph Node Removal Matters:

Lymph nodes are an essential part of your immune and drainage system. Cancer surgeries sometimes remove lymph nodes to test for spread, but this can disturb lymph fluid circulation and increase the risk of lymphedema (chronic swelling) (ISL, 2020).

  • The more nodes removed or damaged, the greater the risk (DiSipio et al., 2013).

  • However, risk is not only about node number—radiation therapy, weight, infections, and healing issues also play a role (McDuff et al., 2019).

Risk by Number and Type of Lymph Node Surgery:

Different surgical approaches carry different levels of risk:

  • Sentinel Lymph Node Biopsy (SLNB):

    • Typically removes 1–3 nodes.

    • Risk of lymphedema: about 5–10% (DiSipio et al., 2013).

    • If no radiation follows, risk may be even lower (~3–7%) (ISL, 2020).

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  • Axillary Lymph Node Dissection (ALND):

    • Removes 10–20+ nodes.

    • Risk: about 20–30% (DiSipio et al., 2013); some studies report up to 40% when combined with axillary radiation (McDuff et al., 2019).

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  • Pelvic or Inguinal Node Dissections (gynecologic, prostate, melanoma):

    • Reported risk: 20–50%, especially when combined with pelvic/inguinal radiation (ISL, 2020; Rockson & Rivera, 2008).

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  • Radiation Therapy Impact:

    • Radiation to axillary, supraclavicular, or pelvic nodes approximately doubles the risk, even after a sentinel biopsy (McDuff et al., 2019).

    • For example, SLNB + regional radiation: 10–15% risk vs. 5–10% without radiation (DiSipio et al., 2013).

Additional Risk Factors:

Risk is not just about surgery:

  • High BMI (≥30): Risk increases by ~1.5–2× (DiSipio et al., 2013).

  • Post-operative complications (infection, seroma, delayed healing): Strong independent risk factors (ISL, 2020).

  • Age: Older adults may have higher risk due to slower tissue healing (Rockson & Rivera, 2008).

  • Trauma or repeated infections in the limb: May trigger swelling years after surgery (ISL, 2020).

  • Cording (Axillary Web Syndrome, AWS): Evidence is mixed. Some large prospective and retrospective studies show women who develop cording have a higher short-term risk of lymphedema—about 2–3× increased risk, especially if cording appears within the first month after surgery (Brunelle et al., 2020; Ryans et al., 2020). However, long-term follow-up and systematic reviews find the relationship inconclusive (Wariss et al., 2017; Brunelle & Serig, 2024). Clinically, AWS should be seen as a warning sign that justifies closer monitoring.

Compression Garments: What the Research Shows:

a. Preventive Use

  • Not everyone needs a garment. Current guidelines (ISL, 2020; Stuiver et al., 2015) do not recommend routine compression garments for all patients after surgery.

  • Who may benefit:

    • Those with extensive node removal (ALND, pelvic/inguinal dissections) (ISL, 2020).

    • Those receiving regional lymph node radiation (McDuff et al., 2019).

    • Those with early detectable swelling (Stout et al., 2012).

    • People at high risk (e.g., BMI ≥30, infection, multiple risk factors) (DiSipio et al., 2013).

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b. When to Wear

  • During air travel: Cabin pressure can transiently worsen swelling—many guidelines recommend garments during long flights (ISL, 2020).

  • During vigorous activity: Especially within the first year after node removal, compression may reduce transient swelling (Stuiver et al., 2015).

  • At first signs of subclinical lymphedema: Evidence shows early compression may prevent progression to chronic lymphedema (Stout et al., 2012).

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c. Compression Strength (Class)

  • Class I (15–20 mmHg): For prevention and very early signs (ISL, 2020).

  • Class II (20–30 mmHg): For patients with early or mild swelling (ISL, 2020).

  • Class III and higher: Reserved for established or severe lymphedema; requires fitting by a lymphedema therapist (ISL, 2020).

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d. Evidence-Based Summary

  • No universal guideline recommends preventive garments for all node removals (Stuiver et al., 2015).

  • But targeted prevention (those with ALND + radiation, pelvic dissections, or early swelling) has strong support (ISL, 2020).

  • Decisions should be individualized and guided by a certified lymphedema therapist (Stout et al., 2012).

Key Takeaways:

The risk of lymphedema rises with the number and location of lymph nodes removed, and is further increased by radiation and other factors like weight and infection (DiSipio et al., 2013; McDuff et al., 2019). Sentinel biopsies carry relatively low risk, while full dissections with radiation can raise risk above 30–40%.

Compression garments are not one-size-fits-all: evidence supports using them in high-risk cases or at the earliest sign of swelling, rather than for every patient (ISL, 2020; Stuiver et al., 2015). Combined with exercise, skin care, and early monitoring, compression therapy is a cornerstone of modern lymphedema prevention (Stout et al., 2012).

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Scientific References:

  • Brunelle, C. L., Roberts, S. A., Shui, A. M., et al. (2020). Patients who report cording after breast cancer surgery are at higher risk of lymphedema: Results from a large prospective screening cohort. Journal of Surgical Oncology, 122(2), 155–163.

  • Brunelle, C. L., & Serig, A. (2024). Is axillary web syndrome a risk factor for breast cancer-related lymphedema of the upper extremity? A systematic review and meta-analysis. Breast Cancer Research and Treatment, 208(3), 471–490.

  • DiSipio, T., Rye, S., Newman, B., & Hayes, S. (2013). Incidence of unilateral arm lymphoedema after breast cancer: A systematic review and meta-analysis. The Lancet Oncology, 14(6), 500–515.

  • International Society of Lymphology (ISL). (2020). The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the ISL. Lymphology, 53(1), 3–19.

  • McDuff, S. G. R., Mina, A. I., Brunelle, C. L., et al. (2019). Timing of lymphedema after treatment for breast cancer: When are patients most at risk? Int J Radiat Oncol Biol Phys, 103(1), 62–70.

  • Rockson, S. G., & Rivera, K. K. (2008). Estimating the population burden of lymphedema. Annals of the New York Academy of Sciences, 1131(1), 147–154.

  • Ryans, K., Davies, C. C., Gaw, G., et al. (2020). Incidence and predictors of axillary web syndrome and its association with lymphedema in women following breast cancer treatment: A retrospective study. Support Care Cancer, 28(12), 5881–5888.

  • Stout, N. L., Binkley, J. M., Schmitz, K. H., et al. (2012). A prospective surveillance model for rehabilitation for women with breast cancer. Cancer, 118(8), 2191–2200.

  • Stuiver, M. M., ten Tusscher, M. R., Agasi-Idenburg, S. C., Lucas, C., & Aaronson, N. K. (2015). Conservative interventions for preventing clinically detectable upper-limb lymphoedema… Cochrane Database Syst Rev, 2015(2), CD009765.

  • Wariss, B. R., Costa, R. M., Pereira, A. C., Koifman, R. J., & Bergmann, A. (2017). Axillary web syndrome is not a risk factor for lymphoedema after 10 years of follow-up. Support Care Cancer, 25(2), 465–470.

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