Compression garments after lymphatic drainage: what to wear and when

Compression garments are worn after lymphatic drainage because the hands-on treatment moves fluid out of a swollen area, but it can't stop fluid from coming back. A well-fitted garment holds the reduction between sessions. Which garment, how firm, and how many hours a day depend on why you're swollen, where, and what your surgeon or physician has advised.

I'm Raegan Brumer, a Registered Massage Therapist and Licensed Practical Nurse, and compression is part of nearly every lymphatic treatment plan at my practice in Kensington, Calgary. This article covers garment types, daily wear, fit problems, replacement timing and what Alberta's public program funds.

Why do I need compression after lymphatic drainage?

If you've read about what manual lymphatic drainage is, you know it encourages fluid to move toward healthy lymph nodes. What it doesn't do is change the tissue's tendency to refill. Once the limb is softer and smaller, gravity, activity and the underlying lymphatic problem start pushing fluid back within hours.

Compression counters that. External pressure reduces how much fluid leaks out of small blood vessels and helps the muscles pump what's already there back toward the trunk. In the Cochrane review of lymphatic drainage for breast cancer-related lymphedema, bandaging on its own reduced arm swelling by roughly a third, and adding manual drainage improved on that by a few percentage points. Compression does a large share of the job; skip it and most of what each session achieves is lost.

After surgery, the garment also supports healing tissue, limits bruising and fluid pockets, and helps skin settle. Your surgeon prescribes it for those reasons before any lymphatic therapist is involved.

What kinds of compression garments are there?

Bandages versus garments. In the intensive phase of lymphedema treatment, when the goal is to bring the volume down as far as possible, therapists use multilayer short-stretch bandaging reapplied every day or two. Bandages adjust as the limb shrinks; a garment can't. Once the volume has stabilised, usually after a few weeks, you're measured for a garment to maintain the result. Measuring too early means a garment that's loose within a month.

Circular knit. The seamless, stretchy garments most people picture: ready-made in standard sizes, thinner, more comfortable under clothing. They suit limbs with a regular shape, mild swelling and venous conditions. Because the fabric stretches easily, it tends to bunch and bind in skin creases on an irregular limb.

Flat knit. Knitted in a flat panel and sewn with a seam, using a denser yarn with less stretch. Usually custom-made, flat knit can be shaped around a conical limb, lobes or skin folds without rolling or cutting in. For established lymphedema, firmer tissue or a limb that's lost its shape, it's the standard choice. It's stiffer, warmer and costs more.

Day and night garments. Knit garments are designed for daytime, when you're upright and moving. At night, when pressure needs are lower, many people switch to a padded foam garment, an adjustable wrap with hook-and-loop straps, or bandages. A survey of North American lymphedema practitioners cited a study in which people using night compression kept close to ninety percent of their volume reduction, against just over half with daytime compression alone. Not everyone needs it, but it's worth asking about if swelling creeps back by morning.

Post-surgical garments. After liposuction, abdominoplasty or body contouring, your surgeon will specify a compression garment, binder or faja, usually in two stages: a firmer first garment worn around the clock for the first week or two, then a lighter second-stage garment for several more weeks. The timing and duration are your surgeon's call, and I don't change them. What I can do is check that the garment isn't digging in, and work around it during treatment.

What do compression classes mean?

Garments are graded by the pressure they apply at the ankle or wrist, in millimetres of mercury (mmHg). Two systems are in use, which is where the confusion comes from. In North America, garments are sold in ranges such as 15–20, 20–30 and 30–40 mmHg. European garments made to the German RAL standard are labelled Class 1 (18–21 mmHg), Class 2 (23–32 mmHg) and Class 3 (34–46 mmHg), and the scales don't map neatly onto each other. A "Class 2" is not simply a "20–30".

For most lymphedema the working range is 20 to 40 mmHg. The right class is a clinical decision made from your assessment, your tissue, your circulation and your ability to get the garment on. Firmer is not automatically better; a garment you can't put on is a garment you won't wear.

How long do I wear it each day?

For lymphedema maintenance, the daytime garment goes on in the morning, before you've been upright long enough for swelling to build, and comes off at night unless you've been given a night garment. On treatment days, put it back on as soon as the session ends, when the limb is at its smallest and the garment fits best.

If you're new to compression, build up: wear it for your most active hours first, then extend toward a full day. Tell your therapist if a full day isn't workable rather than quietly abandoning it; a different garment, a lower class or a wrap usually solves the problem.

After surgery, follow your surgeon's schedule exactly. Around-the-clock wear in the early weeks, off only to shower, is typical, but the duration varies by procedure and surgeon.

Signs your garment doesn't fit

A garment should feel firm and supportive, not painful. Take it off and reassess if you notice any of the following:

• Numbness, tingling or pins and needles in the fingers or toes, or the hand or foot changing colour. That's too tight. Remove it and contact whoever fitted it.
• A band that digs in at the top, elbow, knee or ankle. A tight band acts like a tourniquet and traps fluid below it.
• Rolling or folding over at the top edge. Never fold the top down to shorten it; the doubled fabric creates the same tourniquet effect. The garment needs a different length or a grip top.
• Swelling above or below the garment, or new hand or foot swelling when you wear a sleeve or stocking without a glove or toe cap. The pressure is pushing fluid to the wrong place.
• Skin marks that don't fade soon after removing it, or broken skin at a seam.
• Bagging or wrinkles when it's on. A loose garment isn't controlling anything.

Fit changes with weight, treatment and time. If your body has changed since you were measured, you need to be re-measured, not a new copy of the old garment.

How often should garments be replaced?

Every elastic fabric loses its recoil. With daily wear and washing, a garment typically holds its pressure for three to six months, after which it looks fine but isn't doing the work. Most people need two of each garment so one can be washed while the other is worn, so a pair lasts roughly six months to a year.

Care extends that life. Wash after every wear or two in cool water with a mild detergent, by hand or in a mesh bag on a gentle cycle. No fabric softener, bleach, dryer or radiator; press the water out and lay it flat. Apply lotion at night, not under the garment. Sagging, thinning fabric, persistent wrinkles or a garment that's suddenly easy to pull on all mean it's finished.

Is compression covered in Alberta?

Partly, for some people. Alberta Aids to Daily Living (AADL) funds ready-made compression stockings and lymphedema sleeves for Albertans with chronic lymphedema or advanced venous disease, up to four garments per limb in a twelve-month period. Clients pay 25 percent of the cost up to a family maximum of $500 per benefit year; people with low income can apply for an exemption.

For lymphedema, the program requires assessment by a certified lymphedema therapist or specialty assessor, or a physician or nurse practitioner prescription where neither is available; garments come from an approved vendor with a certified fitter. Custom flat-knit, night and post-surgical garments are generally outside the program, so check before assuming anything is covered. Many extended health plans reimburse garments with a physician's prescription, usually with an annual cap.

I do garment measurement and fitting as part of lymphedema care at my practice, and I'll tell you plainly whether an AADL route or a private purchase makes more sense for you. For how garments fit into the overall plan, I've written about what lymphedema treatment in Calgary actually involves.