Breast and Chest Wall Oedema
When we think about lymphoedema after breast cancer treatment, swelling of the arm and hand is often the first thing that comes to mind. However, breast cancer-related lymphoedema (BCRL) can affect other areas of the body, including the breast, chest wall, armpit and trunk.
Breast and chest wall oedema can occur on its own or alongside the more widely recognised swelling of the upper limb. This is an important distinction because swelling in these areas can be overlooked or mistaken for normal post-treatment changes. Understanding what breast and chest wall oedema looks like, why it develops and when to seek formal assessment can help people access appropriate care following breast cancer treatment.
What is Breast and Chest Wall Oedema?
The lymphatic system plays an essential role in maintaining fluid balance by collecting excess fluid and proteins from tissues and returning them to the circulation.
Breast cancer treatments, particularly surgery and radiation therapy, can alter lymphatic tissue and therefore the lymphatic system’s ability to transport fluid effectively. When lymphatic drainage is impaired and the remaining pathways cannot adequately manage the fluid load, oedema (an accumulation of fluid within the body’s tissue) can develop. When this occurs as a result of lymphatic dysfunction, it may be classified as lymphoedema.
Following breast cancer treatment, oedema (swelling) can be present in:
- The breast, any remaining or reconstructed breast tissue
- The chest wall
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The armpit (axilla)
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The side of the chest and surrounding trunk
- The upper abdomen
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The upper limb, including the arm and hand
The location and extent of swelling varies between individuals. Some people experience changes in just one area, while others develop swelling across several body regions.
Signs and Symptoms of Breast and Chest Wall Oedema
Breast and chest wall oedema can present in different ways. Symptoms may be subtle, particularly in the early stages, or become more noticeable over time.
Common signs and symptoms include:
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Swelling or fullness: The breast, chest wall, area around the armpit or trunk may feel fuller or appear larger in size than usual
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Heaviness or tightness: The affected area may feel heavy, stretched or uncomfortable
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Changes in skin texture: The skin may appear thicker, feel firmer or develop an orange-peel-like appearance
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Changes in breast shape or symmetry: One side may appear more swollen or different from its usual appearance
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Aching or discomfort: There may be tenderness, pressure or a persistent aching sensation
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Changes in clothing fit: Bras, bra bands or clothing may feel tighter
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Reduced movement: Tightness, discomfort or associated tissue changes may affect shoulder movement, reaching or everyday activities.
Not everyone will experience all these symptoms. Some people notice visible swelling, while others primarily experience changes in sensation, tissue texture or comfort. It is also important to recognise that these symptoms are not exclusive to lymphoedema.
Post-surgical changes, infection, inflammation and other conditions can cause similar symptoms. An individualised clinical assessment is important to help identify the underlying cause, determine whether lymphatic dysfunction may be contributing, and guide appropriate management or further investigation.
How is Breast and Chest Wall Oedema Assessed?
Breast and chest wall oedema following breast cancer treatment can be difficult to identify, particularly in its early stages. Swelling may be subtle, fluctuate over time, or occur without obvious changes in appearance. For this reason, assessment should not rely on visible swelling or symptoms alone.
A physiotherapist with expertise in lymphoedema assessment and management (Accredited Lymphoedema Practitioner) can conduct an individualised assessment that considers the person’s breast cancer treatment history, lymphoedema risk factors, symptoms and physical findings.
Assessment may include:
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Medical and treatment history: Review of breast cancer treatment history, relevant medical conditions, current medications, and other factors that may influence lymphatic function and oedema risk
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Symptom assessment: Discussing changes such as heaviness, tightness, fullness, tenderness or altered sensation in the breast, chest wall, armpit or surrounding areas
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Clinical examination: Assessing the breast, chest wall, axilla and upper limb for swelling, changes in tissue texture, skin changes, asymmetry and other findings that may indicate the development of oedema
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Measurements and monitoring: Taking appropriate measurements of the breast, chest wall and upper limb, where clinically indicated, to establish a baseline and monitor changes over time
Why is Assessment and Ongoing Monitoring Important?
Anyone who has undergone breast cancer treatment can be at risk of developing oedema or lymphoedema as a result of their treatment. This is why early assessment and ongoing monitoring are highly recommended, even in the absence of visible swelling or other noticeable symptoms. The absence of noticeable swelling does not necessarily mean lymphatic function is normal and waiting until swelling is obvious may mean a missed opportunity for early intervention.
Individualised assessment and ongoing monitoring can help identify changes from a person’s baseline, investigate new or subtle symptoms, and guide recommendations for further assessment or management when indicated. The frequency and approach to monitoring should be individualised based on treatment history, risk factors, clinical findings and stage of recovery, supporting timely intervention to manage symptoms and minimise the risk of condition progression.
How is Breast and Chest Wall Oedema Managed?
Management of breast and chest wall oedema is guided by the underlying cause, clinical findings, symptom presentation and impact on daily function. An individualised approach helps determine the most appropriate management strategies for each person, based on their specific needs and clinical presentation.
Management of breast and chest wall oedema may include:
Individualised education and self-management strategies: Education helps people understand their symptoms, recognise changes and participate in their ongoing care. This may include guidance on skin care, monitoring for signs of infection, understanding lymphoedema risk and knowing when to seek further assessment.
Exercise and movement: Appropriately prescribed exercise can support lymphatic circulation, shoulder mobility, upper limb function and general physical wellbeing following breast cancer treatment. Exercise can also assist with managing treatment-related limitations, including reduced mobility, discomfort and tissue tightness. Exercise recommendations should be tailored to the person’s recovery, treatment history, symptoms and functional capacity.
Compression therapy: Selected individuals may benefit from compression garments or specialist compression solutions, depending on the location and presentation of the oedema. Compression for breast and chest wall swelling requires individualised assessment to ensure the garment or product is suitable, comfortable and appropriate for the affected area. Compression is not automatically required for everyone with breast or chest wall oedema.
Manual lymphatic drainage: Manual lymphatic drainage (MLD) is a specialised, gentle manual therapy technique used to encourage lymphatic flow and facilitate the movement of excess fluid from affected tissues. MLD is not appropriate for every presentation and should be considered alongside other management strategies rather than as a stand-alone solution.
Scar mobility and soft tissue management: Following surgery and radiation therapy, some people experience scar tightness, restricted tissue mobility or changes in the flexibility of the chest wall. Where appropriate, targeted physiotherapy can help address these restrictions and improve comfort and movement.
Ongoing monitoring and review: Regular follow-ups help monitor changes in breast, chest wall and upper limb oedema, evaluate the response to management and determine whether further assessment or adjustments to the management plan are required.
Ultimately, the management of breast and chest wall oedema is not a one-size-fits-all approach. Treatment should be tailored to each person’s clinical presentation, symptoms and individual needs, with strategies reviewed and adjusted over time as required. An individualised approach helps ensure that management remains appropriate, effective and responsive to changes in symptoms and function.
How Hunter Rehab Hub Can Help
At Hunter Rehab Hub, we provide specialist physiotherapy services for people preparing for, undergoing or recovering from breast cancer treatment, including those at risk of or experiencing lymphoedema. Our approach recognises that lymphatic changes can affect more than the arm. In addition to the upper limb, we consider the breast, chest wall, axilla and trunk, helping to identify changes that may otherwise go unnoticed.
Our services may include:
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Individualised assessment and clinical diagnosis: Reviewing treatment history, lymphoedema risk factors, symptoms and clinical findings to assess for and identify tissue and lymphatic conditions affecting the breast, chest wall and upper limb, including possible lymphoedema.
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Breast, chest wall and upper limb assessment: Evaluating the breast, chest wall, axilla, trunk and upper limb for swelling, changes in tissue texture, skin appearance, tissue mobility and function to identify potential lymphatic changes and other tissue-related conditions.
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SOZO® bioimpedance spectroscopy: Using the SOZO digital health platform, where clinically appropriate, to assess fluid changes in the upper limb and support the assessment and monitoring of BCRL. Results are interpreted alongside clinical findings and other relevant measurements.
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Individualised management recommendations: Providing education and discussing appropriate strategies, which may include exercise, skin care, compression options, manual therapy (including manual lymphatic drainage where indicated), scar and soft tissue mobilisation, and other lymphoedema management approaches tailored to the individual’s clinical presentation.
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Ongoing monitoring: Comparing current findings with previous assessments, where available, to evaluate changes over time, monitor response to management and guide recommendations for further assessment or intervention.
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Referral and care coordination: Recommending further medical review, diagnostic investigations or referral to other health professionals when findings suggest additional assessment is required.
We understand that every person’s breast cancer treatment and recovery experience is different. Our aim is to provide evidence-informed assessment, education and clinical recommendations tailored to individual needs.
Key Takeaways
Breast and chest wall oedema is an important consideration following breast cancer treatment, yet it can be overlooked when attention is focused primarily on the arm.
Key points to remember:
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Lymphoedema can affect more than the arm. The breast, chest wall, armpit and trunk may also be affected following breast cancer treatment.
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Symptoms may be subtle or absent in the early stages. The absence of visible swelling does not necessarily exclude lymphatic changes.
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Regular monitoring matters. Baseline measurements are helpful, but monitoring remains valuable even when no baseline is available or treatment was completed years ago.
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Assessment should be individualised. Clinical examination, relevant measurements and appropriate monitoring tools can help guide clinical recommendations.
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Management depends on the individual. Exercise, skin care, compression therapy, manual lymphatic drainage and other interventions may be considered according to clinical findings and individual needs.
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Not all swelling is lymphoedema. Post-surgical changes, infection, inflammation and other conditions may cause similar symptoms and should be considered during assessment.
Recognising breast and chest wall oedema is an important part of comprehensive care after breast cancer treatment. Knowing what to look for, attending appropriate follow-up assessments and seeking advice when changes occur can help people make informed decisions about their ongoing care.
At Hunter Rehab Hub, we encourage people to seek advice about lymphoedema risk and monitoring, even if they feel well and have no obvious swelling. Early assessment can help establish a useful baseline, identify changes and guide appropriate next steps.
Contact Us
Have questions about breast and chest wall oedema following breast cancer treatment? Contact our team on 0480 604 578 or use the enquiry form below to learn more about our specialist breast cancer rehabilitation services.
References
Brunelle, C. L., Boyages, J., Jung, A. W., Suami, H., Juhel, B. C., Heydon-White, A., Mackie, H., Chou, S.-H. S., Paramanandam, V. S., Koelmeyer, L., & Taghian, A. G. (2024). Breast lymphedema following breast-conserving treatment for breast cancer: Current status and future directions. Breast Cancer Research and Treatment, 204(2), 193–222.
Fearn, N., Llanos, C., Dylke, E., Stuart, K., & Kilbreath, S. (2023). Quantification of breast lymphoedema following conservative breast cancer treatment: A systematic review. Journal of Cancer Survivorship, 17(6), 1669–1687.
Shah, C., Whitworth, P., Valente, S., Schwarz, G. S., Kruse, M., Kohli, M., Brownson, K., Lawson, L., Dupree, B., & Vicini, F. (2023). Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: Clinical practice guidelines. Breast Cancer Research and Treatment, 198(1), 1–9.
Todd, M. (2017). Identification, assessment and management of breast oedema after treatment for cancer. International Journal of Palliative Nursing, 23(9), 440–444.
Verbelen, H., Tjalma, W., Dombrecht, D., & Gebruers, N. (2021). Breast edema, from diagnosis to treatment: State of the art. Archives of Physiotherapy, 11, Article 8.
NSW Government. (n.d.). Lymphoedema. https://www.nsw.gov.au/health-and-wellbeing/cancer-support/breast-cancer/patient-resources/lymphoedema
Disclaimer
This content is general in nature and provided for educational purposes only. It is not a substitute for individualised advice, diagnosis, or treatment. If you have concerns about your symptoms or health, consult a qualified healthcare professional.
