It has been postulated that airplane flight might initiate lymphedema in patients at risk for the disease, or exacerbate the condition [2]. The proposed mechanism is low cabin pressures and/or reduced activity. However, both retrospective [3] and prospective [4, 5] studies have showed that air travel does not negatively affect lymphedema.

Injections and venipuncture generally are avoided in an extremity with lymphedema because of the concern that these interventions will: (1) cause cellulitis and/or (2) worsen the patient’s lymphedema. Although incidental cuts are much more likely to cause cellulitis in a patient with lymphedema, sterily breaking the skin does not increase the risk of infection [1, 5, 6]. For example, cellulitis from venipuncture in a limb with lymphedema has never been reported [6]. Lymphangiography, which necessitates a sterile incision to access lymphatics for dye injection, did not cause an infection in 32,000 lymphangiograms [7]. Injections of radiolabelled colloid during lymphoscintigraphy do not cause cellulitis [8]. Sterile incisions during resection of lymphedematous tissue also are not associated with infection. Liposuction, which requires as many as twenty 1 cm incisions, is not complicated by infection and reduces the risk of cellulitis [9]. After staged skin and subcutaneous excision, which includes long incisions from the hand/foot to the axilla/groin, patients have a reduced incidence of cellulitis [10]. A prospective study did not find an association between needle sticks and lymphedema in breast cancer survivors [5]. Although no evidence exists that sterily penetrating lymphedematous skin worsens the disease or is harmful to the patient, it is reasonable to use the non-diseased limb when possible. Patients with bilateral disease can be reassured that injections or venipuncture in one of their affected limbs is not harmful to them.

Many health care providers are hesitant to perform blood pressure measurements on patients with lymphedema or who are at risk for the disease because of the possibility that the pressure from the cuff will damage lymphatics. However, no evidence exists that using a blood pressure cuff increases the likelihood of lymphedema or worsens the disease. In fact, a blood pressure cuff might be beneficial to patients because pressure is the primary method used to treat a lymphedematous extremity (e.g., multilayer bandaging, massage, custom-made garments, pneumatic pumps). Compression garments can exert pressures up to 80 mmHg, while pneumatic pumps emit a force up to 150 mmHg [6]. These compression modalities have been shown to be safe and significantly improve lymphedema [9, 11].

Additional evidence contradicting the possibility that blood pressure measurements are harmful to an extremity at risk for lymphedema is derived from data on extremity tourniquets. Tourniquets exert pressures of 250–350 mmHg to occlude all blood in an extremity (arterial, venous, lymphatic) for periods of up to 2 h without any evidence of lymphatic injury [12]. In addition, tourniquets are used during suction-assisted lipectomy to remove lymphedematous tissue [9] and have not caused lymphedema in patients at risk of developing lymphedema (i.e., have a history of lymph node dissection) [12]. If hours of using a pneumatic pump, months of continuous wearing of pressure garments, and tourniquet use are not harmful to the lymphedematous limb, then sporadic blood pressure readings will not cause injury either. A prospective study also has shown that blood pressure measurements do not increase the risk of lymphedema in women who have been treated for breast cancer [5]. Pressure from the blood pressure cuff may even improve lymph drainage proximal to the site of application.

Patients with lymphedema often associate an incidental blunt trauma with the onset of their disease. It may be possible that blunt trauma may expedite the onset of lymphedema in an individual who would have otherwise presented later with the condition. However, it is very unlikely that blunt trauma can result in lymphedema because secondary lymphedema is hard to cause. For example, even after removing axillary lymph nodes and radiating the area, only 1/3 of women with breast cancer develop upper extremity lymphedema [13]. Unlike blunt trauma, a penetrating injury to the axillary or inguinal area could severe lymphatic vessels and nodes resulting in lymphedema; although the risk would be much lower than lymphadenectomy or radiation. Blunt traumas to extremities are very common and thus are likely to be temporarily related to the onset of lymphedema from another cause.

No evidence exists that a certain diet is beneficial or harmful to patients with lymphedema [14]. Consequently, individuals are educated that they may eat any type of food as well as drink alcohol [5]. However, diet might indirectly affect lymphedema because obesity can increase the risk of developing the disease or cause the condition [15, 16]. Patients are advised to maintain a normal body mass index because obesity causes inflammation, which damages lymphatic vessels and worsens lymphedema [17]. Obese patients, or individuals at risk for obesity, are referred to a dietician or surgical weight loss center.

Patients with lymphedema are often prescribed diuretics because of the misconception that patients have a “fluid” overload problem. Eight percent of patients referred to our center with lymphedema have been treated with a diuretic [18]. Unlike congestive heart failure, lymphedema is not caused by excess systemic fluid. Instead, high-protein fluid is located outside of the vasculature in the interstitial space. Consequently, diuretics (or fluid restriction by diet) will not improve lymphedema. Diuretics may worsen lymphedema by increasing the osmotic gradient between the vasculature and interstitial space; these drugs also can cause electrolyte abnormalities for patients. Diuretics or fluid restriction is not recommended for peripheral lymphedema by the International Society of Lymphology [14].