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Postmastectomy lymphedema is a well-known sequelae of breast cancer treatment. In patients undergoing axillary dissection and radiation, the incidence of overt lymphedema is as high as 40%. The lymphatic system is a series of lymph vessels and lymph nodes that help drain the fluid surrounding the cells in your body.

What Occurs During Surgery?

These lymph vessels may be cut during surgery to treat breast cancer, especially if you require an axillary lymph node dissection (removal of lymph nodes in your armpit). As a result, this fluid may not drain as effectively from your arm, leading to lymphedema and swelling. Aside from axillary dissections, patients with a high body-mass index (over 30) or those patients who are undergoing radiation therapy may also be more likely to develop lymphedema after surgery.

The swelling that results from lymphedema can be significant, and often interferes with daily activities such as getting dressed or just moving around. Lymphedema also causes your immune system to be less effective at fighting infections in the affected area, meaning that simple cuts, scrapes, or insect bites could turn into something serious. Over time, fibrous and fatty tissue can begin to grow in the affected limbs and make it harder to reverse the swelling.

Prevention

The LYMPHA (lymphatic microsurgical preventive healing approach) technique is currently the only procedure that is able to reliably reduce the risk of lymphedema in patients undergoing surgery. In the LYMPHA procedure, a fluorescent dye is injected to identify lymphatic vessels that have been cut during surgery, some of which may be as small as 0.3 millimeters (around 1/64th of an inch). These lymphatic vessels are then sewn, using ultrafine sutures, to a nearby vein so that the lymph vessels can re-establish drainage and flow.

Only a small number of surgeons have experience with identifying these sub-millimeter lymphatic vessels, performing lymphatic microsurgery and managing the aftercare and potential complications that can arise with lymphedema. Dr. Tanna is one of the few specialized surgeons with the microsurgical background and expertise in this procedure. The LYMPHA procedure is best performed at the time of mastectomy and/or axillary lymph node dissection. Therefore, it requires your surgeon to identify if you are a candidate before your planned breast surgery.

Treatment

Unfortunately, no definitive cure exists for lymphedema. Daily therapeutic management of lymphedema can involve wearing compression garments around the affected area, exercises or pumps to stimulate fluid drainage from the area, and wrapping bandages around the affected limbs. Lymphatic therapists can work closely with patients who have lymphedema to provide these non-surgical treatments.

Surgical options for lymphedema treatment include a lymph node transfer, where lymph nodes from the groin are transplanted to the affected area, or a lymphovenous anastamosis, where lymphatic vessels are microsurgically connected to nearby veins in order to increase the amount of fluid drained from the affected area. However, neither of these options are definitive or permanent treatments for lymphedema. In addition, they work best when the lymphedema is still in its early stages.

In the image above, a patient undergoes lymphatic reconstruction (LYMPHA) at the time of mastectomy and axillary lymph node dissection. The cut lymphatics that drain the arm are surgically diverted into a nearby vein, re-establishing outflow from the arm. ICG flouroescent imaging is performed in the operating room to confirm that the microsurgical bypass is patent.

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