How do you manage breast lymphedema after radiation?  

We refer to lymphedema physical therapist for management.

Answering this question as if it is referring to in-breast lymphedema. I am mindful of identifying women who have residual post-operative in-breast edema prior to radiotherapy or at higher risk based on anatomy. For these women, I prescribe either a compression bra or binder and suggest regular use....

For patients at risk for lymphedema (ex. ALND, RNI, etc), we will refer to breast therapy for exercises and consideration for compression sleeves. For more severe lymphedema, consideration for wrapping, CDP, and interventions occurs.

A strategy taught to me many moons ago is radial massage therapy using lotion from the areola outwards. It is very effective and can be done safely at home. It not only relieves the edema, but it also retrains the lymphatics to open back up again to also provide durable relief.

Both massage and compression bra are effective. I also refer to a lymphedema physical therapist to teach pts proper massage techniques. It is important that the physical therapist be a lymphedema specialist. As we move more towards PBI option, these side effects are less frequent.