Is lymphatic drainage beneficial after breast cancer?

Lymphatic drainage: is it compatible with breast cancer?

In cases of active cancer, lymphatic drainage is generally not recommended.

This is due to the role of lymphatic vessels in transporting cells and molecules throughout the body, whose activation could theoretically facilitate the dissemination of tumour cells. Biologically, lymphatic flow is closely linked to immune response mechanisms and the regulation of the tumour microenvironment. Tissue manipulation could therefore interfere with immunosurveillance processes or contribute to a more favourable environment for tumour progression.

In reality, the role of the lymphatic system in cancer is complex and can be examined from two perspectives: a potentially negative effect and a protective function. On one side, lymphatic vessels may facilitate the dissemination of cancer cells, modulate lymphocyte activity and contribute to the infiltration of immunosuppressive cells. On the other side, they participate in immune surveillance, recruit lymphocytes to combat tumour cells and can limit tumour progression through the action of certain immunotherapies. In view of this duality and as a precautionary measure, lymphatic drainage is contraindicated in individuals with active cancer.

Adverse effects of the lymphatic system	Positive Effects of the Lymphatic System
Facilitation of cancer cell metastasis	Enhanced immune surveillance of tumour antigens
VEGF-C signalling capable of suppressing T lymphocyte activity	Enhanced recruitment of T lymphocytes to combat tumour cells
VEGF promotes the recruitment of immunosuppressive leucocytes.	Delayed tumour growth in combination with immune checkpoint inhibitors
Lymphatic abnormalities and recruitment of inflammatory cells contributing to fluid accumulation in tumours	Lymphatic drainage can reduce fluid accumulation in tumours

The beneficial and detrimental effects of the lymphatic system on cancer progression.

Source: CHOI D. et al. The ambivalent nature of the relationship between lymphatics and cancer. Frontiers in Cell and Developmental Biology (2022).

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What are the benefits of manual lymphatic drainage following breast cancer?

While manual lymphatic drainage is contraindicated during the active phase of breast cancer, it can be beneficial after surgery, particularly following an axillary lymphadenectomy, a surgical procedure to remove lymph nodes from the armpit. In this context, lymphatic drainage is integrated into comprehensive care programmes, also combining topical treatments, exercises and compression bandaging. This helps to reduce lymphoedema that commonly occurs after surgical management of breast cancer, as well as the associated pain and discomfort. Several scientific reviews have indeed confirmed the effectiveness of this holistic approach to lymphoedema management, although the precise role played by lymphatic drainage remains uncertain.

When integrated into a comprehensive programme, manual lymphatic drainage could help reduce arm volume and the discomfort associated with post-mastectomy lymphoedema.

Several clinical studies have therefore assessed the benefits of manual lymphatic drainage following breast cancer. The table below summarises four studies.

Study	Objective of the study	Number of participants	Protocol	Results
ZÜMRE & al. (2005)	Comparative study between complex decongestive physiotherapy (CDP), including manual lymphatic drainage sessions, and standard physiotherapy (SP), without manual lymphatic drainage, following breast cancer surgery.	53 female patients presenting with unilateral lymphoedema following breast cancer treatment (27 in CDP, 26 in SP).	CDP: lymphatic drainage, bandaging, rehabilitative exercises and topical care. SP: bandaging, rehabilitative exercises and topical care. Three sessions per week for four weeks.	Both groups exhibited improvement, but the oedema reduction was significantly greater in the CDP group (-55.7%) compared with the SP group (-36%).
DEVOOGDT & al. (2011)	Study on the prevention of lymphoedema following axillary dissection.	160 female patients with unilateral breast cancer undergoing axillary lymph node dissection (79 with MLD, 81 without MLD).	6-month programme: exercises, lymphoedema prevention advice and manual lymphatic drainage for the intervention group. 12-month postoperative follow-up.	After 12 months, the cumulative incidence of lymphoedema was comparable between the two groups: 24% with MLD versus 19% without MLD. The time to lymphoedema onset did not differ either.
Escalada et al. (2011)	Crossover trial comparing manual lymphatic drainage and low-frequency electrotherapy.	36 women with chronic upper-limb lymphoedema associated with breast cancer.	Cross-over study: 10 sessions of manual lymphatic drainage followed by 10 sessions of low-frequency electrotherapy (or vice versa), separated by a one-month washout period. Assessments before and after each treatment.	Efficacy of both treatments, with no significant difference between them (mean reduction in lymphoedema of 19.77 mL and a notable decrease in pain reported by the patients).
GRAM & al. (2018)	Comparative study of complete decongestive therapy (CDT) with or without manual lymphatic drainage (MLD).	77 female patients with post–breast cancer arm lymphoedema (38 with MLD, 35 without MLD).	Twice-weekly treatment over four weeks. T+MLD group: complete decongestive therapy (CDT) including manual lymphatic drainage. T–MLD group: CDT without MLD. Seven-month follow-up to assess reduction in lymphoedema volume.	Significant reduction in lymphoedema volume in both groups (-6.8% vs -5.7%), with no statistically significant difference between them.