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