Post-Mastectomy Lymphoedema: The Role of Lymphatic Drainage

The lymphatic system is a network of vessels and nodes (glands) that carries lymph — a fluid rich in proteins and immune cells — from the tissues back into the bloodstream.

When axillary lymph nodes are removed during a mastectomy (sentinel node biopsy or axillary clearance), or when radiotherapy damages the lymphatic vessels, the normal flow of lymph is disrupted. Fluid accumulates in the tissues, causing the characteristic swelling.

Not all women who undergo a mastectomy develop lymphoedema — the risk depends on the number of lymph nodes removed, the use of radiotherapy, body weight, and other factors. For this reason, early assessment by a specialist physiotherapist is invaluable.

Common signs and symptoms include:

• A feeling of heaviness or tightness in the hand or arm
• Visible swelling in part or all of the upper limb
• Difficulty moving the wrist, elbow, or shoulder
• A feeling of numbness or discomfort
• Tightness from clothing, a watch, or rings
• Recurring infections in the limb (cellulitis)

If you notice any of the above, seeking help promptly can make a significant difference. Important: this article is not a substitute for an individualised clinical assessment — please consult a healthcare professional for a proper diagnosis.

Manual Lymphatic Drainage (MLD) is a specialist massage technique performed by a trained physiotherapist. Using light, rhythmic movements on the skin, it stimulates the flow of lymph towards healthy lymph nodes, bypassing the damaged areas.

This is not a conventional relaxation massage — the pressure applied is minimal and the movements are slow and methodical. The aim is to "offload" the accumulated lymphatic fluid from the swollen tissues.

You can read more about our lymphatic drainage methods on our services page, as well as in our article on Brazilian Lymphatic Drainage.

In modern lymphoedema management, manual drainage is not used in isolation. It forms part of a broader treatment framework known as Complete Decongestive Therapy (CDT):

• **Manual Lymphatic Drainage (MLD):** the primary technique for reducing the oedema
• **Compression Bandaging:** applied after each session to maintain the results
• **Specialist Exercises:** simple movements that activate the body's lymphatic pumps
• **Skin Care:** moisturising and protecting the swollen area from infection
• **Patient Education:** the patient learns how to manage their condition in daily life

CDT is delivered in two phases: the intensive phase (frequent sessions aimed at reducing swelling) and the maintenance phase (sustaining results over the long term).

Manual lymphatic drainage as part of CDT is supported by a significant body of clinical evidence and is recognised by guidelines from organisations such as the European Society of Lymphology. In general, the findings show that:

• CDT can reduce the volume of the swollen limb in a large proportion of patients
• Mobility of the shoulder and hand improves
• The feeling of heaviness and discomfort is reduced
• Quality of life improves significantly

Of course, outcomes vary depending on the stage of lymphoedema, adherence to guidance, and individual response. Early intervention — before the lymphoedema progresses — is generally associated with better results.

Ideally, assessment by a physiotherapist specialising in the lymphatic system takes place during the post-operative period, before any symptoms appear. This so-called "prophylactic" or "primary prevention" approach includes education on proper hand care, avoidance of risk factors, and gentle exercises.

However, if lymphoedema has already developed, treatment can begin at any point. Bear in mind:

• Avoid extreme temperature changes to the limb (sauna, hot baths)
• Do not have blood taken or blood pressure measured on the affected arm
• Wear gloves when gardening or cooking to avoid minor injuries
• Maintain a healthy body weight — obesity worsens lymphoedema
• Speak with your oncologist before starting any physiotherapy intervention

For many patients following a mastectomy, travelling to a clinic or hospital can be exhausting — especially during chemotherapy or immediately after surgery. Home physiotherapy is an exceptionally practical solution: the physiotherapist comes to your home and performs lymphatic drainage in a familiar, comfortable environment.

Konstantinos Danalis offers specialist home lymphatic drainage sessions in Voula, Vouliagmeni, Vari, Glyfada, and Alimos, tailored to the needs of each patient following a mastectomy or other oncological procedure.

In addition to drainage sessions, your physiotherapist will teach you simple exercises you can do at home every day:

• Slow, circular movements of the shoulder and elbow to activate lymphatic flow
• Deep breathing exercises that act as a "pump" for the lymphatic system
• Gentle strengthening exercises — always agreed with your therapist
• Self-drainage techniques performed according to specialist guidance

In some cases, Clinical Pilates may be incorporated at a later stage to improve overall function and posture — always following an assessment.

Each lymphatic drainage session typically lasts 45–60 minutes. After a session, many patients report a feeling of lightness in the limb and a reduction in tightness — although results vary from person to person.

During the intensive phase, sessions are usually recommended several times a week. In the maintenance phase, the frequency is reduced and the patient learns to self-manage a large part of their care.

If you have any questions or would like to find out whether lymphatic drainage is right for you, please get in touch with us to arrange an initial assessment — at your home or at our clinic.