Physiotherapeutic treatment of post-mastectomy lymphedema

The follow-up of patients who have had surgery for breast cancer is most often the responsability of the general practitioner, the rehabilitation physician or the rheumatologist. They are the ones who will refer the patient to a physiotherapist in case of development of arm lymphoedema in the weeks following the operation.
Interview with Christian Mercier, physiotherapist DE + DU of Lymphology, Le Havre-France.

What are the main pathologies of your patients?

CM: We mainly treat primary and secondary lymphedemas of the lower or upper limbs, as well as phlebedemas. 75% of our patients suffer from post-mastectomy lymphedema. However, in recent years, we have noticed an increase in the treatment of lower limb lymphedema and a significant decrease in the risk of upper limb lymphedema formation.

What therapeutic approach do you use to treat arm lymphedema?

CM: We manage post-mastectomy lymphedema with intensive treatments and then maintenance treatments to stabilize the edema. The entire decongestive protocol includes:

  • Advice on precautions to be observed
  • Rehabilitation exercises
  • Skin care
  • Manual lymphatic drainage
  • Bandaging and exercises with bandages
  • Patient training in self-massage and self-drainage
  • 20-30 minute pressotherapy sessions, in conjunction with the use of Mobiderm® devices between the skin and the massage sleeve
  • Wearing of a compressive sleeve during the stabilization phase.

What results do you observe with pressotherapy?

CM: The effects are immediate. The edema is softer and easier to treat. And patients leave the office with a real sensation of well-being. Pressotherapy is an essential part of the treatment: it enhances the effects of the whole rehabilitation work done with the patient.
When patients are stabilized, we advise them to use, if they can, a pressotherapy device at home. It is really practical and helpful for them to be able to do a session when needed, between two appointments with the physiotherapist.

How long have you been using pressotherapy?

CM: We have been using Eureduc pressotherapy medical devices since 1989 and we were at the time in relation with the physiotherapist who designed them! They are quality products, solid and reliable.

We now have 9 of them to be able to treat all the patients who are referred to us.

Precisely, it seems that some doctors are sometimes reluctant to use pressotherapy. Have you experienced this?

CM: In fact, this reluctance goes back to 1985, when the health insurance covered manual lymphatic drainage. Some people concluded that a mechanical treatment was not appropriate.
But the view has gradually changed with the communications made on pressotherapy and above all, the benefits are there! Mechanical drainage does not mean that we leave patients alone with the machine! We monitor all the steps of the treatment process.

Thank you Christian Mercier for this testimony!