Dr Feldman on the Prevention and Management of Breast Cancer–Related Lymphedema

Sheldon Feldman, MD, chief, Breast Surgery and Breast Surgical Oncology, professor, Department of Surgery, director, Breast Cancer Services, Montefiore Einstein Comprehensive Cancer Center, discusses the strategies to prevent and manage breast cancer–related lymphedema.

Feldman explains that by selectively removing lymph nodes according to the lymphatic drainage patterns and preserving the lymph nodes connected to the arm whenever possible, the risk of lymphedema in patients with breast cancer can be significantly reduced.

Beyond surgical techniques, Feldman also underscores the value of proactive monitoring to detect early signs of lymphedema. Traditional detection methods often rely on patients reporting symptoms such as arm swelling, which could indicate that lymphedema has been ongoing for a period of time, he says. Feldman advocates for a more preemptive approach—known as prospective surveillance—to identify early changes in arm volume before symptoms arise.

This surveillance involves the use of bioimpedance spectroscopy, which is a noninvasive technique that measures fluid levels in the arm. At Montefiore, Feldman notes that this is performed via bioimpedance spectroscopy with the SOZO Digital Health Platform. Feldman explains precise baseline measurements prior to surgery as well as during follow-up visits allow for the detection any changes in arm volume. If an increase is observed, indicating the potential of lymphedema, patients are promptly evaluated for further treatment, Feldman adds.

Feldman notes that early intervention with compression garments has been effective means of reversing early volume changes, thereby preventing the progression to full-blown lymphedema. The combination of selective lymph node removal and vigilant, early detection through advanced surveillance techniques represents a significant advancement in the management of breast cancer­–related lymphedema, he concludes

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Sheldon Feldman, MD, discusses prevention and management strategies for breast cancer–related lymphedema.

Dr Feldman on New Approaches for Decreasing the Risk of Breast Cancer–Related Lymphedema

Dr Feldman on New Approaches for Decreasing the Risk of Breast Cancer–Related Lymphedem

Sheldon Feldman, MD, chief, Breast Surgery and Breast Surgical Oncology, professor, Department of Surgery, director, Breast Cancer Services, at Montefiore Einstein Comprehensive Cancer Center, discusses new approaches for decreasing the risk of and managing breast cancer­–related lymphedema.

Feldman explains that being mindful of which patients require surgery of the axilla can help reduce the risk of lymphedema in the breast cancer population. He emphasizes that advances in the understanding of tumor biology and axillary imaging, such as ultrasound, have allowed for more accurate assessment of necessary treatments, including whether the axilla needs to be removed. This approach significantly reduces the risk of lymphedema, since avoiding surgery on lymph nodes entirely eliminates this risk, he says.

For patients who do need axillary surgery, Feldman notes that it is crucial for surgeons to have a thorough understanding of axillary anatomy. Medical education typically covers the anatomy, but practical application requires recognizing that axillary lymph nodes drain both the breast and the arm, he says. Lymphedema occurs when the lymphatic drainage of the arm is disrupted during the removal of lymph nodes.

To mitigate this, Feldman suggests that surgeons identify and preserve lymph nodes that specifically drain the arm during breast cancer surgery. Feldman explains that "smarter axillary surgery" can significantly reduce the incidence of lymphedema.

Reducing the risk of lymphedema in patients with breast cancer involves a more selective approach to axillary surgery, leveraging tumor biology, and using advanced imaging to avoid unnecessary lymph node removal, he continues. Exploring more conservative treatment methods may represent a shift towards more informed and anatomically precise surgical techniques, Feldman concludes.

Sheldon Feldman, MD discusses new approaches for decreasing the risk of and managing breast cancer¬–related lymphedema.

Sheldon M. Feldman, MD

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Dr Feldman on the Prevention and Management of Breast Cancer–Related Lymphedema

Dr Feldman on New Approaches for Decreasing the Risk of Breast Cancer–Related Lymphedema