Manual Lymphatic Drainage Technique

1. Manual Lymphatic Drainage Technique Karmanos Cancer Institute Lymphatic Drainage Massage Technique for Female Client Presenting Mastectomy of Left Breast and Axilla Node Removal

2. Four Major Types of Mastectomies A SUBCUTANEOUS MASTECTOMY removes the entire breast, but leaves the nipple and areola (the pigmented circle around the nipple) in place. TOTAL (OR SIMPLE) MASTECTOMY is the removal of the whole breast, but not the lymph nodes under the arm (axillary nodes). In a MODIFIED RADICAL MASTECTOMY, the whole breast and most of the lymph nodes under the arm (axillary nodes) are removed. Removal of these lymph nodes is called an axillary dissection. RADICAL MASTECTOMY involves removal of the chest wall muscles (pectorals) in addition to the breast and axillary lymph nodes. For many years, this operation was considered the standard for women with breast cancer, but it is rarely used today. It is mostly of historical interest.

3. These Massage Techniques Should Be Practiced • Before Bandaging • Before Pumping • Whenever You Have Time Compression bandaging compensates for the diminished skin and tissue pressure associated with lymphedema and helps to prevent the limb from refilling with lymph.  Bandaging follows every Manual Lymphatic Drainage.

4. Treatment Protocol-Phase 1 • Phase 1 - Intensive Clinic Program • 5 times/week in clinic. • 2 to 4 weeks duration. • Bandages worn 23/24 hours per day, 7 days a week. • Bandages removed when patient arrives in clinic. • Patient washes extremity before treatment begins. • 45 minutes of manual lymph drainage massage. • Massage is immediately followed by reapplication of bandages. • Education is on-going and includes exercise, edema prevention, skin and wound care, long-term self-management, self-bandaging. • Patients with severe lymphedema may need to return yearly (for a few years) for a brief intensive repeat of Phase 1. • Before Bandaging • Before Pumping • Whenever You Have Time

5. Treatment Protocol-Phase 2 Before After • Phase 2 - Self Management • Continuation of self-bandaging in the evening or wearing of night device such as the Reid sleeve or the Legacy . • Compression garments are worn during the day. • Regular exercises are performed with compression bandages or garments on. • Regular self massage. • Skin care and prevention guidelines followed meticulously. • Self measuring to monitor limb size.

6. The Lymphatic Massage Technique • Friction movement. Fingers keep contact w/skin. No gliding. • Push, by lightly rocking in the direction you want to move lymph. • Gentle, shallow. If skin is red you are pressing too hard. • Sequence is: PUSH, ROCK (roll hand in ½ circle), RELAX. 5-7 REPEATS.

7. 2 1 Client Prone 2. Sweep Transverse away from axilla to uninvolved side. 1. Sweep Inferiorly away from axilla.

8. 2 2 1 Client Supine 2. Across Shoulder toward Neck. 1. Base of the Neck

9. Repeat 3b. 3c 3a 4 3d 3b Client Supine 3a. Axilla 3b. Side up to Axilla 3c. Mid chest above breast to the side. 3d. Mid chest, below breast to side. 3. On Uninvolved Side 4. Across Chest-involved axilla to uninvolved axilla.

10. Deep Breathing Technique • Place hands on abdomen, just inferior to xiphoid process • Deep inhalation through mouth. • Apply pressure as they exhale through mouth. 4 6 5 5. Leg Bend. Client Supine 6.From involved axilla to leg bend Alternate #6 & #4

11. Repeat #8 & #7 Repeat #9, #8, #7 4 Alternate #6 & #4 7 6 8 9 10 7. Upper arm, Triceps & medial arm thumb fans. Client Supine 10. Hands and Fingers 8. Elbow Repeat #4 9. Forearm