Surgery for Lymphedema
Lymphedema (swelling) of the arm can be an unfortunate after-effect of breast cancer treatment. It happens most often in women who have had surgery and radiation to their underarm area (axilla) to treat lymph nodes where their breast cancer may have spread. These treatments sometimes block the flow of lymph. Lymph is a fluid that normally travels in tiny channels up the arm, through the axilla and into a major vein near the collarbone.
At Seattle Cancer Care Alliance, your team will teach you how to reduce your risk for lymphedema and how to manage lymphedema if it develops. We have staff in our Women’s Wellness Clinic, Survivorship Clinic, and physical therapy department to help women who experience lymphedema.
Generally, lymphedema is treated with specialized massage and with compression. Some patients wear elastic compression sleeves on their arms to keep swelling down. In severe cases, the swelling can be difficult to control.
Until recently there has not been any good surgical option to treat lymphedema. However, in recent years several new procedures have been developed. For most patients, these procedures don’t cure the lymphedema. But they provide relief from swelling and discomfort, and they generally make the lymphedema easier to manage. In a small number of patients, the lymphedema resolves completely.
The following procedures are performed by plastic surgeons at University of Washington Medical Center for women who develop lymphedema after breast cancer treatment:
- Lyphaticovenular anastomosis
- Lymph-node transfer
Lymphaticovenular anastomosis (LVA) was developed by Dr. Isao Koshima in Tokyo, one of the pioneers of modern microsurgery. It involves making several small skin incisions in the affected arm. Just under the skin, the lymphatic channels can be found. The surgeon joins several of these channels to nearby veins so lymph can empty into the venous system, without having to go through the axilla. LVA is performed under an operating microscope and requires a high level of skill. It takes about four hours. Because the incisions are not deep, there is very little post-operative pain and the patient can go home the same day.
Lymph-node transfer involves removing lymph nodes from elsewhere in the body (the groin or the neck) and transferring them to the axilla. These lymph nodes are transferred with the blood vessels that nourish them, and these blood vessels are attached to blood vessels in the axilla. After the procedure, the transferred lymph nodes start to drain lymph from the affected arm. Lymph node transfer is a more complex procedure than LVA. It involves a four-to-five hour operation and a three-to-five day hospital stay. Recovery is fairly rapid, and patients can expect to be back to normal in three to four weeks. With this procedure and with LVA, the reduction in swelling is gradual; it takes place over a period of about one year after the surgery.