Lymphedema is the build-up of protein-rich fluid in part of the arm, leg or trunk when the lymphatic system’s transport capacity falls or the lymphatic load rises. It is most often seen after breast cancer surgery and lymph-node removal, after radiotherapy, or due to a congenital insufficiency of the lymphatic system.
Lymphedema does not resolve on its own, but it is a condition that can be brought under control with the right therapy. Therapy started early both reduces the swelling markedly and prevents hardening of the tissue and recurrent infections (erysipelas).
At my clinic in Kağıthane I apply lymphedema therapy with Complete Decongestive Therapy (CDT) — considered the international standard of the field — according to the Földi technique. The process starts with measurement and is followed by measurement, so we talk about progress in centimeters rather than guesswork.
Who is it suitable for?
- People whose arm swells after breast cancer surgery and axillary lymph-node dissection
- People who develop leg swelling after gynecological or prostate cancer treatment
- People noticing an increase around the arm/leg after radiotherapy
- People with congenital (primary) lymphedema
- People with heaviness or tightness in a limb, or rings/shoes becoming tight
- People who have recurrent skin infections
What are the symptoms of lymphedema?
Lymphedema often begins insidiously. Before swelling becomes visible, patients usually notice the following:
- A feeling of fullness, heaviness or tightness in the arm or leg
- Rings, watches, socks or shoes becoming tighter than before
- The skin retaining an indentation when pressed (pitting)
- Skin folds becoming prominent and the skin thickening
- Restricted joint movement and quick fatigue
- Recurrent redness and infection in the same area
What is Complete Decongestive Therapy (CDT)?
CDT is the approach accepted worldwide as the gold standard in lymphedema therapy. The foundations of manual lymphatic drainage go back to Emil Vodder, while the structure that turned this technique into a holistic model rests on Prof. Michael and Ethel Földi. The method I apply at my clinic is the Földi technique.
CDT is not a single technique but four complementary applications — when one is missing, the result is not lasting.
- Manual lymphatic drainage: very light, rhythmic, directional hand movements that guide the accumulated fluid to working lymph pathways
- Multilayer bandaging with short-stretch bandages: applies low pressure at rest and high pressure when muscles work, preventing the tissue from refilling. This is what sets it apart from elastic wraps.
- Exercise: movements done over the bandage that use the muscle pump to support drainage
- Skin care and education: daily care and lifestyle adjustments that reduce infection risk
Stages of lymphedema (Földi classification)
The length of the program and the expected gain depend largely on the stage at which you present. The Földi classification defines four stages:
- Stage 0 (latent): the lymphatic system’s transport capacity has fallen but there is no visible swelling. There may be a feeling of heaviness and fullness. It is the most valuable period for a protective approach.
- Stage 1 (reversible): edema increases through the day; elevating and resting the limb reduces it. The tissue is soft and pits when pressed.
- Stage 2 (spontaneously irreversible): edema does not resolve with elevation. Fibrosis — hardening — begins in the tissue and pitting decreases. The Stemmer sign is usually positive.
- Stage 3 (lymphostatic elephantiasis): marked increase in volume, skin thickening and changes, and frequent recurrent infections.
How long does therapy take?
Therapy has two phases. In the intensive phase, depending on the degree of edema, sessions are usually held 4–5 days a week for 2–4 weeks; the aim is to bring the limb to the smallest possible volume.
In the maintenance phase the volume gained is preserved. This phase brings in compression garments (sleeve/stocking), a home exercise program, self-applied drainage and periodic control measurements. Lymphedema is a condition that requires lifelong follow-up; but when managed well it can be kept at a level that does not restrict daily life.
Why is self-drainage (self-MLD) taught?
One of the distinctive aspects of the Földi technique is that it does not treat the patient as a passive party in the process. When the intensive phase ends, the process does not stop — only its operator changes.
So before moving to maintenance I teach you a simplified drainage program: where to start, how the hand movement should be, and how much time to allow each day. We work together for a few sessions to make sure you apply it correctly.
A patient who can perform their own drainage is less dependent on the clinic and more stable over the long term.
Why is measurement-based follow-up important?
At every session I take and record circumference measurements at specific points on the limb. This lets both of us see progress concretely; which stage we are at and when to move to maintenance is determined by data rather than guesswork.
What happens in a session?
- 01
First assessment
I listen to your history, examine your skin condition and take circumference measurements of both limbs to determine the degree of edema.
- 02
Manual lymphatic drainage
A painless, very light-pressure drainage application.
- 03
Bandaging
At the end of the session the limb is wrapped in multiple layers with short-stretch bandages. The bandage stays on until the next session.
- 04
Exercise and home program
We work together on the movements to be done over the bandage, and I give you your home program and self-drainage in writing.
Common questions about Lymphedema Therapy
Does lymphedema go away completely?
Is manual lymphatic drainage painful?
How many sessions are needed?
What does the Földi technique mean, and how does it differ from other methods?
Is a compression stocking/sleeve mandatory?
How long after breast surgery should it start?
The information on this page is for general information and is not a substitute for personalized medical advice or diagnosis. A diagnosis is made by a physician. For your complaint, please consult a healthcare provider.