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Lymphatic treatments: options and evidence

Lymphedema treatment usually combines several approaches rather than relying on a single technique. Compression, skin care, movement, self-management, and manual lymphatic drainage play different roles. The combination depends on the diagnosis, affected area, health history, and goals.1,2

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Complete decongestive therapy

Complete decongestive therapy (CDT) is a coordinated management approach. It often includes an active phase to reduce and stabilize swelling, followed by maintenance with compression and daily care. Frequency and duration vary; one drainage session is not equivalent to a full CDT program.12

Manual lymphatic drainage

Manual lymphatic drainage (MLD) uses gentle, directed movements of the skin to support lymph flow. For lymphedema, it is usually part of a care plan that also includes compression, skin care and movement.3

Help reducing swelling

MLD may add to the swelling reduction achieved with compression in some people. In a randomized trial of 50 women with breast-cancer-related arm lymphedema, those with mild swelling had a greater reduction with MLD and compression bandaging than with bandaging alone. This was a finding in a subgroup, rather than an added benefit for everyone in the trial.10 A Cochrane review also found a possible extra benefit when MLD was added to intensive compression bandaging.5

Pain relief

MLD may help ease pain associated with breast-cancer-related lymphedema. A 2022 review of randomized trials found lower pain scores in groups receiving MLD than in comparison groups without it.4

Breast swelling and discomfort after cancer treatment

A small 2026 randomized trial involving 25 women found greater improvements in breast pain and swelling-related symptoms when MLD was added to compression, exercise and education after breast-conserving surgery and radiotherapy. These early findings need confirmation: the study was small, and the groups differed in some symptoms before treatment.11

Benefits vary, and research has not shown a consistent extra reduction in arm swelling for everyone.412 The findings above concern breast-cancer-related arm or breast swelling. They do not establish the same results for lipedema or every type of post-operative swelling.

Compression

Garments, multilayer bandages, and adjustable wraps apply external pressure. Selection and fit depend on swelling, skin, circulation, mobility, and the purpose of treatment. Incorrectly applied bandaging can be harmful or ineffective.1

A fitting should include instructions for application, removal, skin checks, and follow-up. Pressure and wear schedules require individual guidance, particularly where circulation problems, infection, or wounds are present.

Pneumatic compression devices use inflatable sleeves or garments. They may be added for selected people, with appropriate settings and monitoring; they do not replace the rest of the care plan.16

Movement, skin care, and home routines

Movement can support function, strength, and quality of life. Activity should reflect healing, fitness, symptoms, and other health conditions. Skin care helps maintain the skin barrier and identify wounds or infection early.167

Self-massage, bandaging, and equipment use should be demonstrated for your body area and checked while you practise. A routine developed for one patient group may not suit another.8

Assessing progress

Agree on the goal and a review point before committing to a lengthy course. Relevant measures may include swelling, pain, heaviness, movement, garment tolerance, daily function, or quality of life. Time, travel, cost, and work at home also matter.2

For help planning care, see Understanding Your Lymphatic Treatment Options. For local services and contacts, see Finding lymphatic care in Calgary and Alberta.

When treatment should wait

New or unexplained swelling needs assessment for its cause. Seek prompt medical attention for one-sided swelling with pain, warmth, or redness, or a hot, tender area with fever or feeling unwell. Call 911 for sudden shortness of breath, chest pain, coughing up blood, or fainting.79

After surgery, follow the surgical team’s restrictions. This guide compares treatments; it does not prescribe an individual plan.

References

  1. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2023 consensus document. Lymphology. 2023;56:133–151. Official PDF ↩︎1 ↩︎2 ↩︎4 ↩︎5 ↩︎6
  2. DiCecco S, et al. Complete decongestive therapy phase 1: an expert consensus document. Medical Oncology. 2024;41:304. https://doi.org/10.1007/s12032-024-02407-4 ↩︎1 ↩︎2 ↩︎4
  3. Canadian Lymphedema Framework. Getting treated. Accessed September 16, 2026. https://www.canadalymph.ca/getting-treated/ ↩︎
  4. Lin Y, et al. Manual lymphatic drainage for breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. Clinical Breast Cancer. 2022;22(5):e664–e673. PubMed record ↩︎1 ↩︎2
  5. Ezzo J, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews. 2015;(5):CD003475. Cochrane evidence summary ↩︎
  6. PDQ Supportive and Palliative Care Editorial Board. Lymphedema (PDQ®): Health Professional Version. National Cancer Institute. Updated December 18, 2024. https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq ↩︎1 ↩︎2
  7. MyHealth.Alberta.ca. Cellulitis. Current as of December 4, 2024. https://myhealth.alberta.ca/health/Pages/conditions.aspx?hwid=tr5105 ↩︎1 ↩︎2
  8. University Health Network. How to Do Lymphatic Self-Massage on Your Lower Body. Revised November 2024. Patient-education PDF ↩︎
  9. HealthLink BC. Deep Vein Thrombosis. Current as of December 19, 2022. https://www.healthlinkbc.ca/healthwise/deep-vein-thrombosis ↩︎
  10. McNeely ML, Magee DJ, Lees AW, Bagnall KM, Haykowsky M, Hanson J. The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial. Breast Cancer Research and Treatment. 2004;86(2):95-106. PubMed | DOI ↩︎
  11. Erkol FN, Alaca N, Bese N, Uras C. Effect of Manual Lymph Drainage on Breast Edema After Breast-Conserving Surgery and Radiotherapy: A Preliminary Randomized Controlled Trial. Cancers. 2026;18(10):1510. PubMed | Publisher | DOI ↩︎
  12. De Vrieze T, et al. Manual lymphatic drainage with or without fluoroscopy guidance did not substantially improve the effect of decongestive lymphatic therapy in people with breast cancer-related lymphoedema (EFforT-BCRL trial): a multicentre randomised trial. Journal of Physiotherapy. 2022;68(2):110-122. PubMed | DOI ↩︎