Immediate lymphatic reconstruction for breast cancer

Abstract

Upper extremity lymphedema remains a significant source of morbidity in breast cancer patients despite significant improvements in breast cancer care. The risk of lymphedema is particularly elevated in patients requiring an axillary lymph node dissection and/or adjuvant radiation to treat their disease. Current treatment options for lymphedema, including conservative management or surgery, are limited and are often aimed at improving symptoms and quality of life rather than curing the disease. In this review we describe immediate lymphatic reconstruction, a novel surgical procedure that is done concurrent with axillary lymph node dissection in an effort to prevent the development of breast cancer-related lymphedema. Based on our growing knowledge of the pathophysiology of lymphedema, microsurgical techniques are used at the time of axillary lymph node dissection to perform a lymphovenous bypass between transected, leaking lymphatic channels and an adjacent, small calibre vein in the axilla. Using several objective metrics for shortand longterm surveillance, patients are monitored for the development of postoperative lymphedema. Early outcomes from using this technique have been promising, both in the literature and within our own institutions, demonstrating significant improvements in rates of postoperative lymphedema. However, future study is still required to better understand the long-term efficacy of immediate lymphatic reconstruction.