Primary prevention
Preventing lymphedema is difficult. Awareness of the condition, and caution when operating near the axilla or groin, may lower the risk of postoperative lymphedema. Minimizing the extent of the surgical procedure and amount of radiation therapy given can also help reduce the risk.[14][44] Lymph node-sparing cancer surgery has been widely adopted over recent decades, and now forms part of the standard of care in the management of some cancers, including breast cancer and melanoma.[10] For example, sentinel lymph node biopsy (SLNB) alone reduces the incidence of lymphedema (5%) when compared with SLNB followed by axillary lymphadenectomy (16%).[14][45] Operative imaging techniques which identify lymphatic vessels to avoid during surgery are being increasingly used.[46] Preventive prophylactic lymphatic-venous shunts or anastomoses may be inserted during surgery in people at higher risk for developing lymphedema postoperatively.[47][48][49]
Randomized controlled trial evidence suggests that use of compression sleeves reduces the risk of arm swelling in women with breast cancer undergoing axillary lymph node dissection.[50] Based on expert opinion, people at increased risk of lymphedema (e.g., due to lymph node removal or radiation therapy) are encouraged to maintain a body mass index within recommended parameters; a cautious program of aerobic and anaerobic exercise with or without the use of compression garments may be recommended, with careful monitoring of symptoms such as pain, discomfort or swelling, suggestive of a need for adaptation of the exercise regimen.[51]
People living for a long time (several months to years) in tropical or sub-tropical areas where filarial species that can cause lymphatic filariasis are endemic, are at the greatest risk for infection.[34] Short-term tourists have a very low risk. Measures to avoid mosquito bites include avoiding outdoor activity after sunset, using insect repellents, wearing long-sleeved shirts and trousers, and using insecticide-treated bed nets. A global campaign to eliminate lymphatic filariasis through preventive chemotherapy with mass drug administration is underway, and has resulted in broad declines in prevalence globally.[9]
Secondary prevention
Infection can be partially prevented with good skin care and prophylactic antibiotics in appropriately selected patients; for example, those with repeated skin infections, with continuing treatment dependent on assessment of the ongoing medical risks and benefits.[47][127] In addition, wearing protective clothing, particularly when outdoors, and avoiding trauma to the skin can help reduce infection risk. Even minor cuts may result in cellulitis, which can worsen lymphedema, as any remaining functional lymphatics are further damaged. Other potential secondary prevention strategies including weight loss, exercise, and self-manual lymph drainage continue to be investigated within randomized controlled trials.[47]
It is considered likely that blood pressure monitoring and venipuncture, when necessary, can be safely performed on the affected extremity if other sites are unavailable, although the level of evidence is low.[131]
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