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Ask Tari: Are there any precautions or considerations for practicing yoga with Breast Lymphedema?

Hi Tari – I have a student with Metastatic Breast Cancer who has lymphedema in her breast from prior treatment. I don’t recall seeing any specific info on breast lymphedema. Most of the info focuses on lymphedema in the limbs. Are there any other precautions or considerations for practicing yoga with breast lymphedema specifically? Thank you for any info!

Hi Pam –

Alas, among side effects of cancer treatment, there are two sneaky categories: the Not so obvious and the Unanticipated.  Because arm and leg lymphedema is more observable and more function limiting, we focus training materials on lymphedema of the extremities. However, lymphedema can occur anywhere in the body, and not always in at the site of node removal. So yes, lymphedema in the remaining breast tissue or anywhere on the chest wall can happen. Likewise, if nodes have been removed from the abdominal area, lymphedema can occur in the legs or on the torso. Understanding that removing nodes wherever they are disrupts lymph flow patterns throughout the body.  Unless it can or until it does find ‘new paths’ to reach the thoracic duct, lymph will collect. That is part of the unanticipated category. Unless you have good knowledge of what nodes were removed where, it is difficult to predict. For example, if the sentinel node and other removed nodes were deep in the center of the chest and not to the side close to the axillary, then that location would create risk for the breast tissue to fill with fluid in search of a path to normalize the flow of lymph.

The other part of this being an Unanticipated side effect category is that your student has Metastatic Breast Cancer (MBC) and there were prior treatments. Unfortunately, when nodes are removed the lymph system is compromised forever. Even if for some time after her first surgeries, lymphedema did not present, years later it can. Reasons why could be related to things like weight gain, lack of exercise or other conditions, infections or disease (like another cancer).  That she is metastatic could be a factor.

Precautions and suggestion:

  • When it comes to lymph, the flow direction is paramount. Yoga can be the ‘muscle’ that keeps it flowing (as the heart is the muscle for the cardiovascular system). Some postures can be obstruction to that directional flow of the lymph. For example, forward bends and maybe even folds – if not done properly – can impact that lymph flow. Thus why we encourage students to keep the spine elongated not round the back to compress the space in the chest that would obstruct lymph flow. This could also happen in prone postures, eg cobra. Use props – like block or bolster – in either case will keep chest lifted and lymph flow unobstructed.

The use of block towers at different heights based on participants flexibility and needs ensures the spine is long and unobstructed. This is to maximize lymphatic flow.

  • Another caution and modification would be taking arms overhead in standing of seated postures. Modify this with the cactus arm position to provide a more gradual flow of lymph with gravity towards the center of the body where the thoracic duct lives.
  • Some care should be taken with some back bends. For example, supported bridge would be more likely to direct the lymph flow to the chest. A better back bend would be supported fish or elevated cobbler.
  • Some suggestions of yoga techniques that would provide benefits, start with focus on pranayama. Clear awareness of how the exhale works to provide deep internal assist to the lymph flow is our best tool. Matching the exhale to the proper movements of the spine in all postures especially in twists and side bends will invigorate the movement of lymph in the central chest area. That will work like a lymphatic massage and may provide relief. Take the concept of unobstructed directional lymph movement as the core of the Step Back sequence to all standing poses using the block towers and matching breath to movement will provide many benefits.
  • Remember that in restorative poses adding a focused patterned pranayama element will give your student control from the inside as a self-lymphatic massage. Teach her things like this to do on her own when anxiety may present.