Lymphatic surgery is an emerging plastic surgery technique that aims to prevent and/or treat lymphedema. Only a small fraction of surgeons across the world are trained in lymphatic surgery because the procedures require training in super microsurgery, the ability to repair injured vessels less than 1 mm in size.

Lymphedema is the accumulation of protein-rich fluid in your body’s tissues. Your veins return 99% of the blood that circulates nutrients to your body back to the heart. The lymphatic system is responsible for the remaining 1%. An injury to the lymphatic system in an area causes that area to be chronically swollen. Over time, this leads to significant tissue changes that can become symptomatic and decrease one’s quality of life. Unfortunately, patients with breast cancer are at risk for developing upper extremity lymphedema. This results in arms, forearms, hands, and fingers that are constantly swollen and heavy and prone to rashes, wounds, and infections. Patients who undergo mastectomy with axillary lymph node dissection (which removes more lymph nodes than a sentinel lymph node biopsy) and adjuvant radiation are at the highest risk of lymphedema.

Overview & Why Choose Dr. Chang

Lymphatic Surgery

  • Lymphovenous Bypass (LVB) / Lymphaticovenular Anastomosis (LVA) – An LVB/LVA is the most common technique used to prevent the development of lymphedema. Dr. Chang works with your breast surgeon to identify any cut lymphatic channels during the lymph node removal using a specialized dye and imaging technology. If a cut lymphatic channel is found, a nearby, redundant vein is used to suture the lymphatic into, so that the lymph fluid drains back into the venous system rather than pooling in your body’s tissues. If performed at the time of lymph node removal, this surgery is performed using the same incision for the lymph node removal. If performed secondarily for patients with early-stage lymphedema, a specialized imaging technology is used to identify where the lymphatic injury is, and an incision is made just before the injury, where the lymphatic channel is still intact to perform a proper LVB/LVA.

  • Vascularized Lymph Node Transfer (VLNT) – A VLNT is a technique used to treat patients with early-stage lymphedema. Vascularized tissue containing lymphatic tissue, commonly from your back or groin, is transferred into the area or lymphatic blockage. Generally, this is in your axilla where scar tissue and possibly radiation have caused injury, collapse, and/or compression of your lymphatics. This technique releases the scar tissue around the veins and lymphatics in the axilla and also transfers in well-vascularized tissue uninjured lymphatics into the area. VLNT can also be performed concurrently with DIEP flap reconstruction in a technique called Total Breast Autologous Reconstruction (TBAR). Patients who are interested in delayed breast reconstruction and also have upper extremity lymphedema are candidates for this. Vascularized lymph nodes are included as part of the DIEP flap and transferred into your axilla at the time of DIEP flap reconstruction.

What Types of Lymphatic Surgery Are There? 

  • Patients without Lymphedema Undergoing Lymph Node Removal – Lymphatic microsurgical preventive healing approach (LYMPHA) is the term given to the practice of repairing injured lymphatics immediately at the time of breast cancer removal in an attempt to prevent the development or lessen the eventual severity of lymphedema. This is generally offered to all patients undergoing axillary lymph node dissection and some patients undergoing sentinel lymph node biopsy.

  • Patients with Early-Stage Lymphedema – Patients with early-stage lymphedema, before the skin shows signs of chronic change, are candidates for lymphatic surgery. For these patients, an attempt will be made to repair the injured lymphatics and/or transfer in healthy lymphatic tissue from another part of your body. Unfortunately, patients who have more advanced staged lymphedema are not good candidates for lymphatic surgery and will benefit more from reductive surgical techniques (liposuction or direct excision) aimed at reducing the size of your extremity.

  • Insurance Coverage – Unfortunately, because this is a newly developed technique, not all insurance companies agree to cover lymphatic surgery. In order to perform this surgery, specialized equipment and medications are required, the cost of which has to be covered by your insurance company.

Who Is a Candidate for Latissimus Dorsi Flap?

Failure to Prevent or Treat Lymphedema

The biggest risk of lymphatic surgery is that it fails to work. There are many factors that play into the development and progression of lymphedema. Unfortunately, these surgical techniques, while the most advanced options we have presently, are not full-proof.

Need for Further Lymphatic Surgery

If the initial lymphatic surgery does not work and you are still bothered by symptoms of lymphedema, you may be recommended for additional lymphatic surgery.

the Risks of Lymphatic Surgery

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