Women in Wales who have been treated for breast cancer are being urged to look out for certain signs and symptoms which could indicate a condition affecting their lymphatic system. Mr Amar Ghattaura, Wales' primary lymphoedema surgeon, has advised breast cancer survivors to watch for a ring that no longer fits, one sleeve feeling tighter than the other, or a sense of heaviness in an arm before any swelling is visible.
Early signs of lymphoedema
Mr Ghattaura explained that such signs could be early indications of lymphoedema, a persistent swelling caused by impaired drainage of lymphatic fluid. The condition is a long-term consequence of breast cancer treatment which can develop months or years after treatment. It tends to occur where lymph nodes have been removed or the area has been treated with radiotherapy.
"Almost nobody's first thought is lymphoedema," he said. "They might think they have put on weight, or that it is down to warm weather. The tightness of jewellery, like a ring, is the one change that patients mention most often because it is the thing they notice without looking for it."
"A watch strap, a bra strap, a sleeve that sits differently on one side - these are the sorts of changes that come before anything looks swollen."
Encouraging early reporting
Mr Ghattaura acknowledged that many women are reluctant to return to a clinic they have only recently left. "You have finished treatment, you are trying to get back to normal, and going back feels like a step backwards. I understand that entirely. But raising it early is not an overreaction."
He explained that recognising the symptoms early greatly increases the treatment options available, allowing patients to undergo microsurgical techniques that reroute lymphatic drainage and procedures that reduce swelling once it is established, rather than simply managing it.
"Patients who were told twenty years ago that nothing could be done were given accurate information at the time," he said. "But it's no longer that way, and that matters most for the patients at the very beginning of their symptoms, because the earlier the condition is identified, the more options there are to treat them."
Risks and background
Mr Ghattaura explained that impaired lymphatic drainage can leave limbs more vulnerable to infection, and said repeated episodes of cellulitis can cause further damage and lead to hospital admission. He set up the first comprehensive NHS lymphoedema surgery service in the UK. As a consultant plastic surgeon at Richmond House Clinic in Penarth, his NHS practice involves complex breast reconstruction and lymphoedema surgery, carried out at Morriston Hospital in Swansea and Llandough Hospital in Cardiff.
Symptoms of breast cancer in women may include a lump or swelling in the breast, chest or armpit; a change in the skin of the breast such as dimpling; a change in the colour of the skin; a change in size or shape of one or both breasts; nipple discharge (if not pregnant or breastfeeding), which may have blood in it; or a change in the shape or look of the nipple, such as turning inwards or a rash on it.
