Anyone who has had surgery or radiation which caused damage to the lymphatic system should monitor their limbs for symptoms of lymphedema. Since surgery and treatment for breast cancer usually results in the removal of or impairment to lymph nodes and vessels, breast cancer patients need to be especially vigilant.

Breast cancer survivors who develop lymphedema are most likely to be affected in the arm next to the breast which has undergone surgery. In other words, if a patient has a lumpectomy or mastectomy performed on their left breast, then their left arm is at risk. If a patient has surgery on or to remove both breasts, then both arms are susceptible. The risk is greater if the patient undergoes radiation of the underarm after lymph nodes have been removed.

For patients who have undergone surgery and/or radiation for breast cancer, it is important to be aware of the signs which indicate lymphedema may be developing. Notify your physician immediately if you experience any of the following symptoms:

• A feeling of fullness, heaviness, or tight skin in an arm or hand
• Pain or aching in an arm or hand
• Jewelry such as a watches, rings or bracelets that feel too tight
• Shirt sleeves or cuffs that feel too tight
• Weakness or decreased flexibility in the fingers, hand or wrist
• Redness, visible swelling, or signs of infection in any part of the limb

If untreated, lymphedema can lead to a host of complications such as infection, limb disfigurement, and severe skin problems. It can also cause permanent damage to blood and lymphatic circulation in the affected limb.

But with treatment, lymphedema can usually be kept in check, especially when detected at an early stage. Breast cancer survivors should memorize the list of symptoms and insist on seeing a physician if they believe lymphedema has developed. Finally, it may be possible to avoid lymphedema by knowing the simple do’s and do not's for patients at risk.

For breast cancer survivors and others at risk, the standard advice for preventing lymphedema boils down to one very general theme: avoid injury or irritation to the limb(s) most likely to be affected.

The human body reacts to injury by producing fluid. In an individual whose lymphatic system has been compromised by surgery and/or radiation, this fluid cannot travel unimpeded and instead becomes mired in surrounding tissues. The end result is lymphedema. Here, in the form of “do’s and do not's”, are the most commonly cited guidelines for protecting at-risk limb(s) from this disorder. While there is no hard scientific proof that these steps will prevent lymphedema, there is a good bit of anecdotal evidence which indicates that observing these guidelines may indeed lower the risk.

Since the upper limbs are at risk with breast cancer survivors, these guidelines are focused primarily on protecting the arms:

Outdoors
• DO protect your arm from sunburn. Wear a sunscreen with a high SPF.
• DO avoid insect bites. Wear insect repellant.
• DO wear gloves when gardening or doing other yard work.
• DO get regular exercise, but avoid repetitive motion with your arm to the point of muscle fatigue.
• DO NOT allow outdoor pets to scratch or bite your hand or arm.
• DO NOT expose at-risk limbs to the extreme heat of hot tubs.
• DO NOT play sports which may result in injury to your arm.
Indoors
• DO wear gloves while doing housework.
• DO wear oven mitts when moving hot plates to and from the oven or burner.
• DO try to avoid burns from grease splatter when frying foods.
• DO NOT allow indoor pets to scratch or bite your arm or hand.
• DO NOT sew unless wearing a thimble to protect against finger pricks.
Hygiene
• DO keep your arm clean and apply moisturizing cream regularly.
• DO thoroughly clean and apply an over-the-counter antibiotic and bandage to any scratch or cut immediately after the injury occurs.
• DO dry your arm thoroughly after bathing, but DO NOT rub the arm harshly with your towel in the drying process.
• DO NOT bathe in extremely hot water.
• DO call your physician immediately if you see any sign of infection.
Grooming and Accessories
• DO wear a soft bra with padded shoulder straps
• DO NOT shave under your arms with a disposable razor. Use a well maintained electric razor with clean heads instead.
• DO NOT cut your cuticles when maintaining your nails. If someone else does your nails, ask them not to cut the cuticles.
• DO NOT wear tight jewelry of any kind on your arm or hand.
• If you wear a breast prosthetic, DO wear a lightweight form.
• DO NOT hang a heavy purse, bag, or briefcase over the shoulder of an at-risk arm.
Travel
• DO wear a compression sleeve anytime you travel by air to compensate for pressure changes in the plane’s cabin.
• DO remember to pack soap, moisturizer, antibiotic cream or ointment, and bandages to maintain your preventive regimen while away from home.
Medical
• DO NOT allow blood to be drawn from an at-risk arm.
• DO NOT allow vaccines or other shots to be given in at at-risk arm.
• DO NOT allow medical personnel to put a blood pressure cuff around an at-risk arm.
• In all three of the above instances, insist that medical personnel use the opposite arm or another appropriate site.
• Finally, DO notify your physician if you see signs of lymphedema developing. If detect any sign of infection, call immediately.

About six to eight weeks after breast surgery it will be time to see the postmastectomy fitter. Women who have had a mastectomy should be able to wear a weighted prosthesis at this time since their incision should be healed. Women who experienced breast conserving surgery will also benefit from a postmastectomy fitting as there are partial prostheses to help fill in the missing portion of their breast and provide symmetry. Most private insurance plans have coverage for breast prostheses and bras. If you are in doubt about your coverage, call the number on your insurance card and inquire.

Who does the fitting?
The fitters are trained, usually by manufacturer based education programs, to fit bras and prostheses. They are taught which products do best with different surgery types, and how to handle special circumstances.

The Fitting Process
The fitting should be conducted in a manner that offers the person being fitted complete privacy.
• The fitter will first assess the condition of the skin at the mastectomy site. There should be no drainage or open wounds at the surgery site, or incision. Either of these conditions would require permission from the patient's physician before proceeding.
• The fitter will determine the proper bra size by taking measurements at strategic points on the chest wall and around the rib cage. The fit of the bra is crucial to how well the prosthesis will be tolerated, and how natural the fit will be. Mastectomy bras today are pretty and feminine while providing the support needed to keep the prosthesis in the correct position. Although it is not mandatory to use a mastectomy bra with a breast prosthesis, it is recommended.
• Next comes the prosthesis recommendation. The fitter will note the shape and drape of the existing breast and try a prosthesis that best approximates those dimensions. Prostheses come in many shapes such as teardrop, triangle, heart shaped and more. Some taper the material into the underarm area to fill in missing tissue there. Some prostheses are symmetrical, meaning they can be worn on either side, others are asymmetrical and are side specific. For women who have lost both breasts, the fitter will make suggestions for prostheses that are flattering to the patient's body dimensions.
• The fitter will place a soft drape or smock on the patient and show the patient in the mirror how she looks with the products chosen. This is where the patient should let the fitter know if she is happy with the results or if she wants to try something else. Most importantly, if the patient is not happy, speak up!
• A yearly visit to the fitter is a good idea. Women's bodies change in response to hormonal changes and weight fluctuations. The natural breast will change in response to these factors and a change in prosthesis may be needed to maintain symmetry.
• Before leaving the fitter's facility, instructions on use and care as well as the retailer's return policy should be given.
• Premium prostheses such as Amoena and Trulife have a two year warranty against manufacturer's defects. This does not include punctures or damage from perfumes or other personal toiletry items. Daily cleaning with Amoena Breast Form Wash or TruKleen by Trulife and storing the prosthesis in it's cradle when not in use should keep your Amoena prosthesis great shape.

It has been estimated that 80% of women wear the wrong size bra. Many women are not aware that they do not have to endure discomfort from their bras. With a simple fitting, a Certified Mastectomy Fitter can recommend which size and style will flatter a women’s appearance and provide the most comfort. Whether or not a women has had a mastectomy, a good fitting bra is essential for creating symmetry.

The National Lymphedema Network (USA) states that poor fitting bras can contribute to the formation of lymphedema of the upper extremities. Bra straps and bands that are too tight are thought to impede the flow of lymph fluid. It is important that someone who has a history of lymphedema have at least yearly bra fittings.

What makes a good fitting bra?
To get a good fitting bra you must first start with a good fitting. The fitter should measure and make recommendations for optimum fit and comfort of her patients. To assess the fit of the bra, the fitter will evaluate all the components of the bra to see how they match with the wearer’s unique proportions. Among these are:

The Band
The bra band should be snug, but not tight, using the middle set of hooks to fasten the bra. With a proper fit, you should be able to comfortable insert 1 finger under the band on each side, front and back. If the band rides up in the back, this is an indication the bra is too large.

The Straps
The straps should fit snugly without cutting into the shoulders and sides. You should be able to get two fingers under the strap. Women who are large breasted or who have a history of lymphedema should always wear a bra with wider straps.
Underwire bras can help take some of the pressure off the shoulders.

The Cups
The cups should not force the breasts toward the sides or the center. There should be a natural looking separation of the breasts. The center portion of the bra should lie flat against the chest wall between the breasts. If the cup is not filled out or if it wrinkles, a smaller size, fiberfill or contour cup may work better. If the breast tissue overflows, a larger cup or a style with more coverage should be suggested. The underarm area should lie smooth without cutting into the flesh.

To test the fit of a bra sit down and take a deep breath. Does the bra feel binding? If so, it may be too snug. Too loose? Maybe the next size down would be better.

Bras should be washed by hand with delicates wash or a mild soap and line dried. This will prolong the elasticity of the fabrics. The average lifespan of a bra is four to six months of daily use. Proper care extends the lifetime of the garment.