Treatment - Lymphoedema

The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT).

DLT is not a cure for lymphoedema. DLT can improve your symptoms but it takes time and effort.

Decongestive lymphatic therapy (DLT)

There are 4 parts to DLT:

• compression bandages – to help move fluid out of the affected limb and reduce more build-up
• skin care – to keep the skin in good condition and reduce the chances of infection
• exercises – to use muscles in the affected limb to improve lymph drainage
• manual lymphatic drainage (MLD) - specialised massage to improve the flow of fluid in the lymphatic system

DLT is an intensive phase of therapy. You may need daily treatment for several weeks. This helps to reduce the volume of the affected body part.

The second phase is the maintenance phase. You'll exercise, use simple self-massage techniques and wear compression garments.

This treatment phase helps to keep the reduced size of the affected body part.

You'll have reviews every few months to check how your treatment is working.

Compression bandages and garments

The lymphatic system has no central pump, such as the heart, to move fluid to the lymph nodes. It uses the massaging effect of surrounding muscles to move the fluid. This is why exercise is important.

You can wear compression bandages or garments to put gentle pressure on your muscles. These include compression sleeves, gloves, stockings or tights.

The combination of exercise and compression helps the fluid to move out of the affected limb.

You may need to wear compression garments after a massage session. This prevents fluid from building up in the limb again.

You can use adjustable wraps instead of bandages or compression garments. These are easier to put on yourself.

Your doctor will teach you how to put on compression garments or adjustable wraps. You can continue using them during the maintenance period.

Skin care

Take care of your skin to reduce your risk of developing an infection, such as cellulitis.

Movement and exercises

Your care team will create an exercise and movement plan for your needs and abilities. This will help strengthen and stimulate the muscles involved in lymph drainage.

They'll also help you lose weight if you're overweight.

Your plan may have limb exercises and gentle activities for the whole body. These can include swimming, cycling and walking.

Massage

You may have massages called manual lymphatic drainage (MLD) from a specialist therapist. MLD helps to move fluid from the swollen areas into working lymph nodes, where it's drained.

Your therapist will also teach you simpler massage techniques. The techniques are simple lymphatic drainage (SLD). You or your carer can do these at home during the maintenance phase of treatment. SLD can help keep the swelling down.

Surgery

In rare cases, you may have surgery to treat lymphoedema.

There are 3 types of surgery for the condition:

• debulking – to remove sections of excess skin and underlying tissue
• liposuction – to remove fat from the affected limb
• lymphaticovenular anastomosis – to restore the flow of fluid in the affected area by connecting the lymphatic system to blood vessels

These treatments may help reduce the size of areas of the body affected by lymphoedema.

Liposuction

The accumulation of fat is a significant feature of lymphoedema swelling. Liposuction removes excess fat from an affected limb to help reduce its size.

During the procedure, your surgeon inserts a thin tube through a small incision (cut) in the skin. Then they use suction to remove the excess fat from the tissue.

After surgery, you must wear a compression garment on the affected limb day and night for at least a year. This helps to keep down the swelling.