Vascularized Lymph Node Transfer Improves Arm Lymphedema after Breast Cancer Surgery

By: Dr. Steven Pisano

Blogs
August 01, 2013

Arm lymphedema (permanent arm swelling) after surgery for breast cancer is a common problem, occurring in 7% of women undergoing sentinel lymph node biopsy and up to about 45% of women undergoing a traditional axillary node dissection. Post-surgical radiation therapy increases the likelihood of upper extremity lymphedema further.

Lymphedema of the upper extremity is characterized by an increase in the circumference of the arm and forearm, pitting (soft) edema (swelling), loss of range of motion at the shoulder and/or elbow, and discomfort. In advance cases the tissues can become markedly swollen, hard, discolored (so called "brawny edema"), and even painful.

Treatment of lymphedema can be divided into non-surgical and surgical options.

The non-surgical treatment includes: range of motion exercises, elevation, “lymphatic” massage, compression garments, intermittent pneumatic compression devices, and multi-layered banding. Non-surgical treatment can be effective in mild to moderate cases. The advantage of non-surgical treatment is that it avoids surgery. The disadvantage is that it may not be definitive in mild to moderate cases and may not be sufficiently effective in advanced cases. Non-surgical methods may be also cumbersome and are usually time-consuming.

Several surgical treatments for arm lymphedema have been described including: lymphatic-to-vascular anastomosis (hook-up), liposuction, direct soft tissue excision from the upper extremity, transfer or transplant of autologous (from the patient) tissue to the axilla, and more recently vascularized lymph node transfer.

Vascularized lymph node transfer has by far shown the best results. The procedure can be performed a couple of ways: lymph nodes can be transplanted at the same time as delayed breast reconstruction with a DIEP flap, or as a stand-alone block of tissue. Both methods can permanently reduce or even eliminate lymphedema and recent reports show a high success rate.

Lymph nodes transplanted with a DIEP flap are typically found along the superficial epigastric vein. Lymph nodes transferred as a stand-alone block of tissue are harvested from the groin area. Lymph node groups are found along the circumflex iliac vessels or branches off the femoral vessels. The lymph node group is transplanted to the arm. The blood supply to the transplanted lymph nodes is connected to blood vessels in either the wrist, antecubital area (inner elbow), or more commonly the axilla (underarm).

At PRMA we offer both non-surgical and surgical treatment of upper extremity lymphedema. Microsurgery is part of our daily practice and we are proud to offer our patients state-of-the-art reconstructive procedures like the vascularized lymph node transfer.

Learn More About Vascularized Lymph Node Transfer

54 Comments

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  • Maricela Padilla

    I would like more information on this surgery!

    Reply
  • Arlene Cunningham

    I wish I had known this was posible when I had my surgery for breast cancer as they took lymph modes from under my right arm and also when I had plastic surgery to remove the dog ears that were left from the first surgery

    Reply
  • Debra Leyna

    I have lymphedema in my right leg due to radiation for a tumor in my pelvic . I have stage 4 breast cancer that has spread to my bones. I’m thankful for a clinical remission for 3 yr. Is there anything possible that can be done to reduce the swelling in my leg we have done compression wraps lymphedema clinic and compression hose

    Reply
  • Dr. Steven Pisano

    If you have lymphedema it is not too late to consider vascularized lymph node transfer. The procedure can be performed well after the mastectomy and lymph node dissection. Please do not hesitate to contact us if you have any questions. Dr P

    Reply
  • Kim Zimmer

    I would love to know more about this surgery. My right arm is double the size of my left.

    Reply
  • Kim

    I’ve had lymph nodes removed as well, & would love more info on this, if possible, by e-mail, thank you

    Reply
  • Brandy Haslam

    Hi Kim, I am sending over an email now. Let me know if you have any other questions. -Brandy

    Reply
  • Brandy Korman

    Hi Maricella, I sent over an email to you with more info. Please feel free to email me at .(JavaScript must be enabled to view this email address) or call 800.692.5565 with any questions. I’d love to help!

    Reply
  • Brandy Korman

    Hi Debra, here is an article by Dr. Arishita that talks about lymphedema and the treatment options. http://prma-enhance.com/useful_resources/blog/01-14-2013/lymphedema-caus.... You may want to check with your clinic to see what else they may recommend for you. Have you already had breast reconstruction?

    Reply
  • Dr. Steven Pisano

    We at PRMA have not yet treated lymphedema of the lower extremity with a vascularized lymph node transfer. However, I did research the topic, and I found a report from earlier this year in our main journal in which vascularized lymph nodes from the neck (supraclavicular area) were transplanted to the leg. The case report involved a patient with severe lymphedema; the lymphedema was reduced (but not eliminated) with the surgery.

    Reply
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