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Johns Hopkins Health - Take Comfort

Fall 2014
Issue No. 26

Take Comfort

Date: October 9, 2014

A surgical option beyond traditional therapy might relieve the swelling and discomfort of lymphedema


People who have lymphedema are all too familiar with the swelling, fullness and heaviness associated with their condition—and the limitations of traditional treatment. Although decongestive therapy remains the primary prescription for lymphedema, a new surgical procedure at Johns Hopkins alleviates the discomfort for some people.

There is no known cure for lymphedema. It can be inherited, caused by injury or, most commonly, developed after removal of lymph nodes during cancer treatment. In fact, about 25 percent of people who have lymph nodes removed from their armpits or groins develop the condition, sometimes years later.

Lymph nodes work as filters that eliminate impurities from fluids in the body. When those filters are removed or damaged, the fluid can back up. Extremities can swell, and infections become more serious.

The first step for people with lymphedema is decongestive therapy, which includes massage, compression therapy and exercise to ease swelling, explains , a certified lymphedema therapist at Johns Hopkins. Those with mild to moderate conditions who do not respond to therapy, however, may be candidates for lymphovenous bypass surgery, which is performed at just a few facilities nationwide. The treatment is not a cure, but it eases symptoms by giving fluid a place to go.

During the surgery, lymphatic channels are connected to veins in the arms or legs, “bypassing the blockage that exists in the armpit or groin,” says Justin Sacks, M.D., a plastic and reconstructive surgeon at Johns Hopkins. The procedure takes four to five hours and is performed under general anesthesia. Patients typically go home the same day and recover quickly.

“It’s not a cure-all,” Sacks says. “But it is the first surgical treatment and has a low risk of complications.”

What to Expect During Decongestive Therapy
Two or more times a week, depending on the severity of the person’s swelling, a physical therapist, an occupational therapist or other specially trained professional massages the affected areas, helping move excess fluid to healthy tissue. The person receiving therapy is given exercises to do to ease swelling and is urged to avoid cuts or scratches, which can get infected and exacerbate the condition.

In between visits, the person wears compression garments to increase tissue pressure and keep fluid moving, and continues with the exercises.

Free Online Seminar

Managing Lymphedema: Discover Your Options
Thursday, November 6, 7–8 p.m. EST

Join Johns Hopkins experts and learn about upper and lower extremity lymphedema treatment and management options, such as decongestive therapy and surgery. Plastic and reconstructive surgeon Justin Sacks, M.D., and certified lymphedema therapist will discuss ways to manage your symptoms and provide answers to your questions. To register, visit