One of the greatest concerns of our breast cancer patients is the development and prevention of lymphedema. Fortunately, there has been recent advances in understanding the causes of lymphedema.
Approximately 5-10% of patients who have undergone radiation treatment and axillary lymph node dissection will develop lymphedema in their arm. The average time to develop these symptoms is about 18 months after the completion of radiation treatment.
The main treatment for lymphedema is manual decongestive therapy. By wearing a compression sleeve or using a lymphedema pump, patients are able to control their symptoms by reducing the amount of fluid in the arm. Many patients dislike compressive garments because they limit every day activities, can be uncomfortable and are hard to cover up. The lymphedema pumps must be used every day and can also be expensive to purchase and replace.
Two recent surgical developments have shown promise in treating lymphedema. The first is called “Vascularized Lymph Node Transfer.” Lymph node transfer allows the surgeon to remove lymph nodes from one area of the body and transfer them to the area where the patient has undergone prior lymph node removal. Common areas from where lymph nodes can be removed and transferred are the lower abdominal area and chest area. We must be mindful to prevent lymphedema from occurring in the areas from where the lymph nodes are removed. Oftentimes, we can transfer lymph nodes at the time of the DIEP flap. In this case, there is no additional hospital time or recovery time apart from the breast reconstructive operation. Such a procedure allows us to remove the changes from radiation that lead to scarring which prevents the flow of lymph fluid. It also allows for replacement of functional lymph nodes into this area. One of our patients, Belinda Hatfield, recently described her experience with this surgery. Click here to read her story and learn more about this procedure.
The second operation is called “Lymphovenous Bypass.” Using microsurgery techniques, the surgeon can reroute a patient’s lymphatic vessels into veins that will also allow for a reduction of lymphedema fluid. LVB can be done in an outpatient setting through small incisions that are made on the arm to locate the lymph vessels and veins.
Although both of these surgical treatments are under active investigation, they offer hope to mitigating the effects of a condition that impacts patients’ quality of life.