Patient Story: Arm Swelling (Lymphedema) Treated with Lymphatic Bypass Surgery by dr. Sara at Mandaya Royal Puri Hospital

Lymphedema is swelling in a part of the body caused by impaired lymphatic fluid flow. It can develop after cancer surgery involving the removal of lymph nodes. The condition may appear months or even years after cancer treatment. Lymphedema is a chronic condition that requires ongoing management. Although it cannot always be completely cured, appropriate treatment can help reduce swelling, relieve symptoms, and prevent the condition from worsening.

One patient at Mandaya Royal Puri Hospital experienced arm swelling caused by lymphedema, which affected her comfort during daily activities. To address the condition, she underwent lymphaticovenular anastomosis (LVA), a lymphatic bypass procedure performed by dr. Sara Ester Triatmoko, Sp.B.P.R.E., Subsp.M.O. (K), at Mandaya Royal Puri Hospital. After surgery, the patient reported feeling more comfortable during daily activities as the swelling in her arm began to subside.

“I feel more comfortable after the procedure. My arm was very swollen before, but as the swelling started to go down, it became easier for me to do things around the house. It has helped me tremendously,” the patient said.

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Arm Swelling Caused by Lymphedema Disrupted Daily Activities

A breast cancer survivor shared that she first noticed swelling in her left arm approximately two years before consulting a doctor. Initially, the swelling would decrease after sleeping or resting. However, over time, it occurred more frequently and eventually no longer subsided. The condition became more concerning when fluid began leaking through the pores of her skin.

The patient had a history of cancer surgery in 2003, followed by chemotherapy. However, she admitted that she had not known that lymph node removal could lead to lymphedema. She was also initially afraid to seek medical attention because she worried that her cancer might have returned. As a result, she left the swelling untreated for approximately two years, until it began interfering with her daily activities.

As someone who enjoyed exercising, cooking, and gardening, the patient found it increasingly difficult to do activities she had previously enjoyed. Her swollen arm felt heavy, restricting her movement and ability to lift objects. Even putting on long-sleeved clothing became difficult as the size of her left arm increased. These challenges eventually prompted her to seek medical treatment.

Following her family’s advice, the patient looked for a doctor specializing in microsurgical reconstruction. She then decided to consult dr. Sara at Mandaya Royal Puri Hospital. In addition to the hospital’s convenient location near her home, she considered dr. Sara’s professional background and the information about lymphedema treatment she had found on social media.

Undergoing Lymphatic Bypass Surgery with dr. Sara and Experiencing Improvements

After undergoing an examination, the patient received treatment for lymphedema through a procedure called lymphaticovenular anastomosis (LVA).

LVA is a surgical procedure designed to help reduce lymphedema symptoms. It involves connecting lymphatic vessels directly to small veins in the affected area. This allows lymphatic fluid to bypass damaged or blocked pathways and re-enter the bloodstream through an alternative route, potentially helping to reduce swelling.

After surgery, the patient also underwent a course of physiotherapy involving manual lymphatic drainage (MLD), following the treatment plan provided by the medical team. This therapy aims to help improve lymphatic fluid flow. After completing approximately 10 therapy sessions at the hospital, the patient continued exercising independently at home, including recommended movements to help manage lymphedema.

The patient reported noticeable changes after surgery and therapy. The swelling in her left arm began to decrease, making daily activities at home more comfortable. Although the arm had not completely returned to its original size, she appreciated the positive changes and understood that improvement could occur gradually.

Based on her experience, the patient encouraged cancer survivors who develop swelling in their arms or other parts of the body to consult a doctor as soon as possible. She believes that even mild swelling should not be ignored, as early examination and treatment may help manage the condition more effectively. She also encouraged patients to follow their doctor’s recommendations and remain consistent with their treatment.

Be Aware of the Signs and Symptoms of Lymphedema

Lymphedema can develop gradually and may worsen over time. Before visible swelling appears, you may experience unusual sensations, such as tingling or numbness, that come and go.

Symptoms of lymphedema after breast cancer treatment may include:

Changes in skin texture or appearance, such as tightness, itching, rashes, redness, or skin hardening.
Pain, tingling, discomfort, or increased warmth in the arm, hand, breast, chest, or armpit.
A feeling of fullness or heaviness in the arm, hand, breast, chest, or armpit.
Stiffness or reduced joint flexibility in nearby areas, such as the shoulder, hand, or wrist.
Sharp, shooting pain or pins-and-needles sensations that may occur suddenly.
Tenderness around the elbow when touched.
Mild swelling in the arm, hand, breast, or chest that may leave a temporary indentation when the skin is pressed with a finger. This is known as pitting edema.
Less visible veins or tendons in the hand, less prominent knuckles, or skin that appears smoother than before.
Fever or flu-like symptoms.

If you experience sudden, severe swelling—for example, if the affected body part becomes significantly larger over a day or two—seek medical attention immediately. This may indicate an infection, a blood clot known as deep vein thrombosis (DVT), or cancer recurrence affecting the lymphatic system.

Mandaya Lymphedema Center: Comprehensive Services from Diagnosis to Treatment

Mandaya Royal Puri Hospital offers the Lymphedema Center, a specialized service dedicated to managing lymphedema, or swelling caused by impaired lymphatic fluid flow. The center serves patients with swelling in the arms, hands, legs, and other parts of the body, including cases that develop after cancer surgery, injuries, or infections. Through a medical examination, patients can undergo an evaluation to identify the cause of the swelling and determine the most appropriate treatment for their condition.

Treatment at the Lymphedema Center is supported by a multidisciplinary team that includes plastic, reconstructive, and aesthetic surgeons with expertise in microsurgery and oncoplastic surgery, rehabilitation medicine specialists, and certified physiotherapists. When necessary, further examinations may involve contrast-based lymphatic mapping to help determine the most suitable treatment options. One available procedure is LVA, or lymphatic bypass surgery, which connects lymphatic vessels to small veins to create an alternative pathway for lymphatic fluid flow.

In addition to surgical procedures, Mandaya provides supportive treatments such as compression devices, or pneumatic compression pumps, and manual lymphatic drainage (MLD), a specialized massage technique designed to help direct lymphatic fluid away from swollen areas.

In selected cases, doctors may also consider lymph node transfer. Not every patient requires surgery, as the treatment plan is tailored to the findings of the medical examination and each patient’s individual condition. Through this comprehensive approach, Mandaya’s Lymphedema Center aims to help patients receive appropriate care to reduce swelling and improve comfort during daily activities.

Consult dr. Sara at Mandaya Royal Puri Hospital for Lymphedema Treatment

dr. Sara Ester Triatmoko, Sp.B.P.R.E., Subsp.M.O. (K), is a plastic, reconstructive, and aesthetic surgeon with subspecialty expertise in microsurgery and oncoplastic surgery. She completed her general medical and plastic, reconstructive, and aesthetic surgery education at Universitas Indonesia before pursuing further training in microsurgery and oncoplastic surgery to support the reconstructive needs of cancer patients.

Her areas of expertise include breast reconstruction after mastectomy and lymphedema treatment using the LVA technique. For breast cancer patients, LVA may be one of the treatment options for lymphedema, particularly arm swelling that can occur when lymphatic fluid flow is disrupted following surgery or radiotherapy.

Before recommending treatment, dr. Sara evaluates each patient’s condition to determine the most appropriate approach. Consultations also help patients understand their condition, the available treatment options, and the goals of the proposed procedure.

dr. Sara’s Consultation Schedule at Mandaya Royal Puri Hospital

dr. Sara Ester Triatmoko, Sp.B.P.R.E., Subsp.M.O. (K), is available for consultations at Mandaya Royal Puri Hospital on the following days:

Tuesday: 5:00 PM–7:30 PM WIB
Thursday: 5:00 PM–7:30 PM WIB

Facilities for Out-of-Town and International Patients at Mandaya Royal Puri Hospital

Mandaya Royal Puri Hospital provides a range of supporting facilities to enhance the comfort of patients traveling from other cities or overseas.

VIP Transportation: A pickup service from Soekarno-Hatta International Airport, train stations, or seaports to the hospital using comfortable vehicles, accompanied by a Patient Experience Officer (PEO).
Medical Ambulance Pickup: A dedicated pickup service for patients with specific medical needs from arrival points, including airports, train stations, and seaports. The service includes medical equipment and assistance from professional healthcare personnel.
Accommodation (Sleep Hub and Apartments): Comfortable accommodation for families accompanying patients, including facilities located on the eighth floor of the Mandaya Royal Puri building and nearby apartment options.
International Patient Relations: Dedicated assistance for international patients with medical coordination, interpreter services, and administrative arrangements. For information and assistance from International Patient Relations, contact 021 5092 8888 or email [email protected].

To make your visit to Mandaya Royal Puri Hospital more convenient, use the WhatsApp Chat feature, Book Appointment, or the Care Dokter application, which is available for download on Google Play and the App Store. These services allow you to arrange appointments, check your queue number, and access other useful information.

The information provided on this page is intended for educational purposes and offers a general overview. It does not cover every type of medical service that each doctor may provide. To determine the most appropriate treatment for your health condition, you are advised to consult the relevant doctor directly.

If you have any questions, suggestions, or need further information, please contact our call center at 0811-1900-2000.