Lymphedema Surgery – How Is It Performed? Can It Resolve Completely? Important Information for Breast Cancer

What Is Lymphedema?

Lymphedema is swelling caused by the accumulation of lymph fluid between tissues. Usually, a single arm or leg is affected. Lymphedema is not caused only by cancer and its treatment; it may occur as a sign or accompanying symptom of many other conditions (such as trauma, burns, infections like filariasis, chronic venous insufficiency and morbid/severe obesity).

Lymphedema in Cancer

The most common cause of lymphedema in people with cancer is the combination of surgical lymph node removal and radiotherapy. The people in whom we most frequently see lymphedema are those undergoing breast cancer surgery with removal of axillary lymph nodes.

The lymphatic system is part of our immune system, which works against infections, foreign bodies and diseases. In medicine, lymph nodes are the name given to the lymph glands, which are also part of the lymphatic system. As shown in the figure above, lymph nodes act like stopping points along lymph vessels. Each armpit contains more than 30 lymph nodes. Surgical removal of lymph nodes may disrupt lymphatic flow and cause lymph fluid to accumulate between tissues, which we call lymphedema. The more lymph nodes removed, the greater the risk of lymphedema.

Recognizing lymphedema early and referring the patient to a physical medicine specialist for early rehabilitation are important. The most common treatments currently used for lymphedema involve various techniques to reduce and improve limb swelling: manual lymph drainage (massage), exercise and compression with special garments or elastic bandages. However, these techniques are time-consuming and may not produce complete results in all patients.

Surgical methods have been explored for treating lymphedema in recent years. Lymphatic bypass and vascularized lymph node transplantation have emerged as 2 effective new methods.

Lymphovenous Bypass and Vascularized Lymph Node Transplantation

Lymphovenous bypass surgery connects blocked lymph vessels to nearby small veins through anastomosis. It often improves lymph flow rapidly. In many patients, particularly those with early-stage lymphedema, lymphatic bypass may provide long-term benefits. In some patients, its effectiveness begins to decrease approximately 12 months after surgery.

In contrast, transplantation of vascularized lymph nodes from another body region does not provide results as quickly as lymphovenous bypass. Ideal lymph flow is generally achieved 6-9 months after surgery.

Combining these two operations is suggested to provide both rapid and lasting relief and may be a powerful treatment for patients with lymphedema.

Lymphovenous bypass and vascularized lymph node transfer together with plastic surgical breast reconstruction

Today, the involvement of plastic surgeons in breast cancer operations allows many women to achieve a more satisfactory breast appearance than in the past. Lymphedema treatment and breast reconstruction can be performed simultaneously, reducing recovery time or hospital stay. Breast reconstruction, vascularized lymph node transplantation and lymphovenous bypass can be combined in a single operation.

Treating Lymphedema with Liposuction

Not all patients may be suitable for lymphovenous bypass and vascularized lymph node transplantation. These procedures offer limited benefits particularly in patients with advanced lymphedema. Liposuction, known as a fat-removal method, can reduce lymphedematous tissue and provide relief.

The affected arm of a patient with lymphedema caused by breast cancer treatment, before (left) and after (right) liposuction. The procedure reduced arm volume by 1.600 mL. Images: Dr. Mark Schaverien, MD Anderson Cancer Center.

Liposuction to reduce swollen tissue in patients with lymphedema is performed similarly to cosmetic liposuction

Choosing the Right Treatment

First, lymphedema should be recognized early and not regarded as an inevitable side effect of cancer treatment. A physical medicine specialist experienced in this condition should be consulted before swelling progresses. Some patients may resolve the problem completely within 6 months using compression therapy and manual drainage. For those who do not respond, lymphedema surgery may be appropriate, and earlier surgery may produce better results.

A comprehensive assessment is necessary to determine whether the patient will benefit from surgery and which procedure should be performed.

- Related topic: As Important as All Cancer Treatments: Oncological Rehabilitation!