Understanding Postpartum Swelling

by: Robert Kessler, MD - Plastic Surgeon, Newport Beach CA

There are two circulatory systems in our bodies. Most people are aware of the arteries and veins which carry blood and nutrients to the cells and removes waste. The second system is the lymphatic system. Blood consists of red cells which stay in the arteries and veins while plasma has the ability to leave the vessels and bathe the structural cells in the body. Plasma leaves blood vessels to perform its function and is collected in the lymphatic system which returns it to the blood stream. The lymphatic channels operate under very low pressure and often require muscular exertion and movement to propel the lymphatic fluid back into the blood stream.

During surgical procedures blood and lymphatic vessels are cut. Blood vessels which operate under higher pressure find alternate paths back into the circulation quickly. Lymphatic channels are very slow to open and fluid accumulates at the surgical site. The trauma of surgery also leads to additional fluids accumulating as well. Blood vessels are repaired in a week while lymphatic channels may require 3 months to repair.

The body’s response to surgery and to spaces created in the body by surgery is to fill the areas with fluids. Plasma has clotting factors and brings the elements of the immune system to concentrate the healing effects in the injured area. Some fluid is beneficial, too much is problematic. This is where compression garments provide tremendous benefit. Compression will maintain contact between the layers in the surgical wound preventing fluid collection which is an early occurrence.

Equally important is to prevent excess fluid from accumulating within the tissue. This will lead to persistent swelling and potential contour irregularities in the area. Compression minimizes the amount of fluid that can physically enter the tissue and will minimize cycles of engorgement and deflation. Compression should be maintained until the lymphatic system has repaired itself and the tissue fluid can pass through the tissues unobstructed. In most cases this is complete by 3 months.