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J Reconstr Microsurg 2016; 32(01): 016-027
DOI: 10.1055/s-0035-1544182
Invited Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Combined Surgical Treatment in Breast Cancer-Related Lymphedema

Jaume Masia
1   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau (Universitat Autonoma de Barcelona), Barcelona, Spain
,
Gemma Pons
1   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau (Universitat Autonoma de Barcelona), Barcelona, Spain
,
Maria Luisa Nardulli
1   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau (Universitat Autonoma de Barcelona), Barcelona, Spain
› Author Affiliations
Further Information

Publication History

27 October 2014

03 December 2014

Publication Date:
13 April 2015 (online)

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Abstract

Background Lymphedema is a well-known sequela of breast but no consensus has been reached about the ideal treatment. Surgical approaches, however, are receiving increased attention. Various microsurgical reconstructive techniques aim to restore anatomy and function of the lymphatic system in upper limb breast cancer-related lymphedema (BCRL). We combined two techniques, lymphaticovenous anastomosis (LVA) and autologous lymph node transplantation (ALNT) after carefully selecting those who may benefit from the surgery. We called this the “combined surgical treatment (CST)” approach.

Methods From June 2007 to December 2011, we performed CST in 106 patients with upper limb BCRL. Clinical evaluation and diagnostic imaging studies were performed preoperatively in all the patients. CST was offered to patients with stage I/II lymphedema, according to the criteria of the International Society of Lymphology (ISL).

Results Overall 59 of the 106 patients underwent LVA, 7 underwent ALNT, and 40 underwent both the techniques. All 47 lymph node (LN)-flaps survived but 11 (22%) required surgical revision within 3 days. A total of 21 LN-flaps (45%) showed no radiotracer uptake at 1 year. Around 1 to 7 LVAs for each patient (average 3.4) were performed. Preoperative versus postoperative excess circumference decreased between 12 and 86.7% (average 39.72%). Arm circumference decreased between 0.9 and 6.1 cm (average 2.75 cm). The number of episodes of lymphangitis per year decreased from 1.8 to 0.2.

Conclusion Preoperative assessment is essential to select patients who can benefit from surgery for lymphedema and to choose the best surgical approach in each case. Our satisfactory results in well-selected cases encourage further research into surgical treatment for BCRL.

Keywords

lymphedema - lymphaticovenous anastomosis - autologous lymph node transplantation - supermicrosurgery - breast cancer-related lymphedema
 

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