A Renu therapist's hands resting on a client's upper chest below the collarbone while her arm is held out to the side

Self-lymphatic drainage for breast and chest-wall swelling

The NHS breast routine: five belly breaths, slow armpit circles, then four breast start points, each stroked 10 to 20 times toward the centre of the chest.

By The Renu lymphatic and massage team · 6 min read

The home routine for a swollen breast or chest wall follows the West Suffolk NHS breast leaflet: five slow belly breaths, five slow circles over the lymph nodes in each armpit with the flat of the hand or a small soft ball, then four start points on the breast, each stroked with the flat of the hand 10 to 20 times toward the centre of the chest, before repeating the armpit circles and the breathing to finish. Every stroke is done on bare skin without cream, firm enough to move the skin but never painful. If lymph nodes were removed from your armpit or you have an active cancer diagnosis, the leaflet asks you to get your clinician's advice first.

Swelling in the breast or along the chest wall after a lumpectomy, radiotherapy or reconstruction is less talked about than arm swelling, but it has its own home routine. The West Suffolk NHS lymphoedema service publishes a breast-specific leaflet, and this page walks through it: breathing, both armpits, then four short routes across the breast that all end at the centre of the chest. It is the routine your lymphedema nurse may have sketched for you on a diagram; here it is written out.

Get the route checked before you start

Two cautions sit at the bottom of the leaflet, and they belong at the top of this page. If you have had any lymph nodes removed, seek your clinician’s advice before massaging the armpit on that side. And if you have an active cancer diagnosis, seek clinician advice before completing the massage at all. Cancer Research UK lists cancer in the area as one of the situations where lymphatic drainage should not be used, alongside infection or inflammation in the swollen area, a blood clot, heart problems, and a blockage of the large vein returning blood to the heart.

The reason a therapist checks the route is that the sequence depends on which nodes are still draining. Macmillan says the therapist begins by treating unaffected lymph nodes, and that the home version is learned from a lymphoedema specialist before you start. Our mastectomy and reconstruction page explains how surgery changes the map.

The breast routine, step by step

Sit or stand with the chest bare. No cream or oil: the leaflet says the massage must be performed on bare skin.

Five belly breaths. Rest both hands on your tummy, breathe in slowly and deeply, and as you breathe out through pursed lips let the hands sink into the abdomen. Repeat five times.
Armpit circles, both sides. Using the flat of your other hand, or a small soft ball, massage the lymph nodes in the armpit with circular movements, five slow repetitions, unless it is painful. Do both sides. This is the step that needs your clinician’s go-ahead on an operated side.
Point 1, the midline. Place the flat of your hand on the affected breast at the inner edge, near the midline, and slowly stroke the skin with slight pressure toward the centre of the chest. Repeat 10 to 20 times.
Point 2, the outer breast. Same technique, from the outside of the breast across to the centre of the chest, 10 to 20 times.
Point 3, the underside. From the bottom of the breast, stroke upward toward the centre of the chest, 10 to 20 times.
Point 4, the outer breast again. A second route from the outside of the breast to the centre of the chest, 10 to 20 times.
Finish in reverse. Repeat the armpit circles, then the five breaths, in that order.

Each route is a slow skin stroke, not a rub. Macmillan’s description of simple lymphatic drainage is the best picture of it: you use your hand to very gently move the skin in a particular direction, always away from the swelling. If your skin is red when you have finished, the movement was too much.

Reading the leaflet’s map

Notice what the four routes have in common. None of them heads for the armpit. The leaflet does not explain why, but it fits what both Cancer Research UK and Macmillan say about where fluid is sent: toward areas that are draining normally, and away from the swollen tissue. After node surgery on one side, the centre of the chest is often the safer destination. Your therapist may adjust this, for example if nodes were removed on both sides, and that is exactly the kind of decision we would rather make with you than leave to a diagram.

Pressure, skin and timing

How firm. The leaflet says that although the massage is firm, you must not cause pain or redness to the skin. Over breast tissue that has been operated on or irradiated, we lean toward the lighter end of that range; the skin should move, and that is all.

Treated skin. Radiotherapy can leave the chest wall tight, dry or more fragile for a long time. Keep the daily skin care going: the West Suffolk daily-care leaflet asks you to pay particular attention to the skin under the breasts and in any deep folds or scars when you moisturise, and to avoid deep tissue massage over swollen areas. The radiation fibrosis page goes into why.

How often. Cancer Research UK gives the usual rhythm as twice a day for about 20 minutes, with the note that your routine might vary. The breast sequence alone is shorter than that. Macmillan suggests choosing a time and place where you can do it in a relaxed way, and doing your deep breathing first.

Breathing between times. Cancer Research UK’s breathing exercise can be done on its own: relax the shoulders and upper chest, rest a hand below the ribs, take a slow deep breath in through the nose feeling the hand rise, breathe out slowly through the mouth so the abdomen flattens, five times. It changes the pressure in the abdomen and chest and encourages lymph to flow back into the blood system.

Bras, vests and support

What you wear over the breast matters as much as what you do with your hands. Macmillan’s guidance: your bra should not be too tight around the chest, and the straps should not dig into your shoulders or under the arm. A sports bra may be comfortable. For ongoing breast or chest-wall swelling, a lymphedema service may provide a compression bra or a specialist vest, and some people also need a compression sleeve for the arm on the same side. At Renu, compression fitting with Meeghan Mackenzie, a Certified Compression Fitter, is a 30-minute appointment for $25.

Stop and call

Do not do the routine, and contact your doctor or lymphedema clinician, if any of these apply:

The breast or chest looks red, feels hot, is painful, or is suddenly more swollen, or you see red streaks, have a fever or feel as if you are getting the flu. Macmillan lists these as signs of cellulitis, and they need same-day care.
You feel unwell or have an infection anywhere. The leaflet says not to perform the massage, and to contact your lymphoedema clinician if unsure.
Any step causes pain or discomfort. The leaflet’s caution is to seek advice from your clinician rather than push through.
You have an active cancer diagnosis and no clinician has yet told you the routine is appropriate for you.
A blood clot is suspected, or you have heart problems. Cancer Research UK lists both as reasons not to have lymphatic drainage.
Lymph nodes were removed and the armpit step has not been cleared for you.

Our when to seek medical care page covers the wider warning signs after cancer treatment.

Where the clinic fits

This routine is maintenance between appointments, not a replacement for them. In a classic lymphatic drainage session the therapist clears the neck, the chest and the working armpit before touching the swollen breast, and that is the sequence we teach you to copy at home. Breast and chest-wall lymphedema that persists is managed through complete decongestive therapy with Meeghan Mackenzie, our Certified Lymphedema Therapist, who will also show you how the breast routine joins up with the arm routine if both are affected.

Questions people ask

Why do the breast strokes go to the middle of the chest instead of the armpit?

The West Suffolk leaflet sends all four routes toward the centre of the chest and separately tells you to seek your clinician's advice before working an armpit where nodes have been removed. It does not spell out the reasoning, but the pattern matches what Cancer Research UK and Macmillan describe: fluid is moved toward areas that are draining normally, away from the swelling. Your own route may differ, which is why a therapist maps it first.

Can I do this if I had radiotherapy to the breast?

Ask your oncology team or lymphedema therapist before you start, and let them look at the skin. The leaflet's rule that the massage must not cause pain or redness matters more over treated skin, and it says not to do the routine at all if you feel unwell or have an infection. Our radiation fibrosis page explains why treated tissue behaves differently.

Can I use a ball instead of my hand on the armpit?

Yes. The leaflet offers a small soft ball as an alternative to the flat of the hand for the armpit circles, five slow repetitions on each side, unless it is painful. The ball is useful if your shoulder is stiff or reaching across is awkward.

What bra should I wear with breast swelling?

Macmillan says your bra should not be too tight around the chest and the straps should not dig into your shoulders or under the arm; a sports bra can be a good option. Some people are fitted for a compression bra or a specialist vest by their lymphedema service. Meeghan Mackenzie is a Certified Compression Fitter and can advise on what is available.

How often, and for how long?

Cancer Research UK gives the usual simple lymphatic drainage rhythm as twice a day for about 20 minutes, with the note that your routine might vary. The breast sequence on its own is shorter than a full limb routine. Macmillan suggests picking a time and place where you can do it in a relaxed way.