Vascularized Lymph Node Transfer
Vascularized lymph node transfer is one of the methods used in the surgical treatment of lymphedema (arm swelling). The procedure involves replacing lymph nodes damaged or removed by previous breast cancer treatment with healthy lymph nodes from another part of the body. This can help restore the lymphatic drainage of the arm and can improve arm lymphedema.
What is Lymphedema?
For women who have undergone breast cancer surgery and/or radiation treatment, arm lymphedema is a possible complication that can occur after treatment.
The axillary lymph nodes can be the first place cancer spreads from the breast which is why they are removed and tested for cancer cells with sentinel lymph node biopsy or more extensive lymph node removal (axillary dissection).
Lymphedema develops when the lymphatic fluid "backs up" in patients who have had lymph nodes removed, had cancer involvement of the lymph nodes, or had radiation to the axilla. It occurs in 7% of women undergoing sentinel lymph node biopsy and up to about 45% of women undergoing axillary node dissection. Post-surgical radiation therapy increases the likelihood of arm lymphedema further.
Signs and symptoms of upper extremity lymphedema after breast cancer treatment can include:
- Swelling in arms, hands, fingers, shoulders or chest
- A feeling of heaviness or tightness
- Restricted range of motion
- Aching or pain
- Decreased flexibility in the hand or wrist
- Hardening and thickening of the skin on your arm
Once lymphedema develops, the affected arm is susceptible to even more swelling. Patients should take care to protect that arm and hand from infection. Avoid cuts, scratches, burns and iv's to that extremity and take care to clean any injuries thoroughly.
There are non-surgical and surgical treatment options for lymphedema.
Non-surgical options must always be maximized before considering surgery. Treatments involve specialized physical therapy from certified lymphedema specialists. Modalities include range of motion exercises, elevation, “lymphatic” massage, compression garments, intermittent pneumatic compression devices, and special types of banding. Non-surgical treatment can be very effective in mild and mild-to-moderate cases.
Vascularized Lymph Node Transfer
Vascularized lymph node transfer involves transplanting healthy lymph nodes from another part of the body, most commonly the groin. These lymph nodes can be transplanted to the axilla (armpit) at the same time as breast reconstruction with a DIEP flap, or as a stand-alone procedure. Both methods can permanently reduce or even eliminate lymphedema in some cases. Currently, PRMA offers the procedure in conjunction with DIEP flap reconstruction or as a stand alone procedure.
Vascularized lymph node transfer will only be considered for patients who have already maximized control of their lymphedema through lymphedema therapy. Patients must also return to lymphedema therapy after vascularized lymph node transfer to ensure the best results.
It is important for patients to know not all insurance providers cover this procedure and patients may be responsible for all surgeon, hospital and anesthesia fees. At PRMA, we verify insurance coverage and obtain authorization prior to surgery so patients can be informed of their cost estimates up front. For easy financing options, Care Credit is available.
- Arm lymphedema is a possible side effect that can occur after breast cancer treatment
- There are non-surgical and surgical treatment options
- Non-surgical treatment in the form of lymphedema therapy from a certified therapist should always be maximized before and after any lymphedema surgery
- Vascularized lymph node transfer involves transplanting healthy lymph nodes from another part of the body
- Lymph nodes are most commonly taken from the groin
- To learn if you are a vascularized lymph node transfer candidate or to schedule a consultation, please contact us here or call us at (800) 692-5565.