Is lymphatic drainage beneficial after breast cancer?

Is lymphatic drainage compatible with breast cancer?

When active cancer is present, 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 promote the dissemination of tumor cells. Biologically, lymphatic flow is closely linked to immune response mechanisms and the regulation of the tumor microenvironment. Tissue manipulation could thus interfere with immune surveillance processes or contribute to a more favorable environment for tumor progression.

In reality, the role of the lymphatic system in cancer is complex and can be examined from two perspectives: a potentially harmful effect and a protective function. On one hand, lymphatic vessels can facilitate the spread of cancer cells, modulate lymphocyte activity, and contribute to the infiltration of immunosuppressive cells. On the other hand, they participate in immune surveillance, recruit lymphocytes to fight tumor cells, and can limit tumor progression through certain immunotherapies. Given this duality and following the precautionary principle, lymphatic drainage is contraindicated in individuals with active cancer.

Negative effects of the lymphatic system	Positive effects of the lymphatic system
Facilitation of cancer cell metastasis	Enhanced immune surveillance of tumor antigens
VEGF-C signaling capable of suppressing T lymphocyte activity	Enhanced recruitment of T lymphocytes to fight tumor cells
VEGF promotes the recruitment of immunosuppressive leukocytes	Tumor growth delay in combination with immune checkpoint inhibitors
Lymphatic abnormalities and inflammatory cell recruitment contributing to fluid accumulation in tumors	Lymphatic drainage can reduce the accumulation of fluids in tumors

The positive and negative effects of the lymphatic system on cancer progression.

Source: CHOI D. & 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 after breast cancer?

If manual lymphatic drainage is contraindicated during the active phase of breast cancer, it can be beneficial after surgery, particularly following axillary lymphadenectomy, the surgical procedure performed to remove lymph nodes from the armpit. In this context, lymphatic drainage is integrated into comprehensive care programs, combining topical treatments, exercises, and compression bandaging. This allows reduce lymphedema that frequently develops after surgical management of breast cancer, as well as the pain and discomfort associated with it. Several scientific reviews have also confirmed the effectiveness of this holistic approach for managing lymphedema, even though the precise role of lymphatic drainage remains uncertain.

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

Several clinical studies have thus evaluated the benefits of manual lymphatic drainage following breast cancer. The table below presents a synthesis of four studies.

Study	Objective of the study	Number of female participants	Protocol	Results
ZÜMRE & al. (2005)	Comparative study between complex decongestive physical therapy (CDP), including manual lymphatic drainage sessions, and standard physical therapy (SP), without manual lymphatic drainage, after breast cancer surgery.	53 patients presenting with unilateral post-treatment breast cancer lymphedema (27 in CDP, 26 in SP).	CDP: lymphatic drainage, bandaging, rehabilitation exercises, and topical treatments. SP: bandaging, rehabilitation exercises, and topical treatments. Sessions 3 times per week for 4 weeks.	Both groups showed improvement, but the reduction in edema was significantly greater in the CDP group (–55.7%) compared to the SP group (–36%).
DEVOOGDT & al. (2011)	Study on the prevention of lymphedema following axillary lymph node dissection.	160 women with unilateral breast cancer underwent axillary lymph node dissection (79 received manual lymphatic drainage, 81 did not).	6-month program: exercises, lymphedema prevention guidance, and manual lymphatic drainage for the intervention group. Postoperative follow-up at 12 months.	After 12 months, the cumulative incidence of lymphedema was comparable between the two groups: 24% with MLD versus 19% without MLD. The time to onset of lymphedema also did not differ.
ESCALADA & al. (2011)	Crossover trial comparing manual lymphatic drainage and low-frequency electrotherapy.	36 women with chronic upper limb lymphedema related to breast cancer.	Crossover 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 were carried out before and after each treatment.	Both treatments demonstrated efficacy, with no significant difference between them (mean reduction in lymphedema volume of 19.77 mL and a notable decrease in pain reported by patients).
GRAM & al. (2018)	Comparative study of complete decongestive therapy (CDT) with or without manual lymphatic drainage (MLD).	77 women with arm lymphedema following breast cancer (38 with MLD, 35 without MLD).	Twice-weekly treatment over 4 weeks. T+MLD group: CDT including manual lymphatic drainage. T−MLD group: CDT without MLD. Follow-up at 7 months to assess lymphedema volume reduction.	Significant reduction in lymphedema volume in both groups (−6.8% vs. −5.7%), with no statistically significant difference between them.