Guest blog: Surgical lymphedema options

Guest blog: Surgical lymphedema options

A guest blog by Dr. Ramon Garza III of PRMA Plastic Surgery, Texas

What is lymphedema?

Lymphedema of the arm is a complication that can occur after undergoing breast cancer treatment.  Patients most at risk for lymphedema are those who have had lymph nodes removed from the arm pit (axilla), have undergone radiation/chemotherapy, and those who have a BMI greater than 30.  The likelihood of lymphedema after breast cancer treatment is between 7-35% depending on risk factors above. 

Lymphedema is the result of mismanagement of lymphatic fluid within our bodies.  Lymphatic fluid is transported by little vessels, similar to veins, back to the circulation. When the lymphatic system is disrupted, the fluid can leak out of the lymphatic vessels and become trapped in the affected limb. The result is lymphedema.

Symptoms of lymphedema

Symptoms of lymphedema are variable.  They can also range in intensity. The most common symptoms include:

  • Expanding and/or swelling of arms, hands, fingers, shoulders or chest
  • A feeling of skin tightness
  • Feelings of heaviness in the arm
  • Limited range of movement
  • Constant or periodic moments of throbbing or pain
  • Diminished range of motion in the fingers, hand, or wrist
  • Thickening and hardening of the skin

Treatments for lymphedema

Although there is no cure for lymphedema, treatment can greatly improve symptoms and improve quality of life! There are many available treatment options for lymphedema, including new advanced surgical techniques.

Before considering any surgical treatment option, it is recommended to be evaluated by a certified lymphedema therapist. They may recommend range of motion exercises, lymphatic massage techniques, and wearing compression garments.  These non-surgical options are important in the treatment of lymphedema. 

After evaluation by a lymphedema therapist, a consultation with a microsurgeon who performs lymphatic surgery is recommended.  Early surgical intervention is important to maximize benefit and prevent worsening of lymphedema.  Surgical interventions are less likely to have a favorable result, once lymphedema has been longstanding and progressed to the later stages of lymphedema.

Surgical options

Surgical treatment options include lymphaticovenous anastomosis (“LVA” hook-up) and vascularized lymph node transfer.

Vascularized lymph node transfer entails replacing missing lymph nodes 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.  Typically, this procedure is performed in conjunction with an autologous flap breast reconstruction procedure like the DIEP flap. However, the procedure can also be performed as a stand-alone surgery.

Lymphaticovenous Anastomosis is one of the newest surgical techniques used to treat lymphedema.  Prior to the procedure, the patient is evaluated in an office setting to determine if they have functioning lymphatic channels amenable to surgery.  A special luminescent dye is injected into the hand and wrist and the lymphatic system will light up on video using a special camera.  Together, the patient and surgeon will see how the lymphatic system is working and determine if the patient is a candidate for surgery. During the surgery, lymphatic channels are rerouted to nearby veins under a microscope. By altering the route for lymphatic fluid to return to the heart, lymphedema can be improved.

Regardless of the surgical treatment option, patients must also return to their regular lymphedema therapy after surgery to ensure the best results.

A common question many patients ask when considering surgical lymphedema treatment options is if the surgery will be covered by insurance.  The answer is not black and white.  Unlike breast reconstruction which is mandated to be covered if the mastectomy was covered, lymphedema surgery is not always a covered benefit for some insurance plans.  In some circumstances the surgical options are still considered to be “experimental.”  This is because the surgical procedure options are still very new and very few surgeons in the country perform this advanced microsurgery technique.  As more long-term research is published proving the success of these options and the vast patient benefit, we hope to see more insurance plans covering these advanced lymphedema treatment procedures. 

Dr. Ramon Garza III is a board-certified plastic surgeon and microsurgeon specializing in advanced breast reconstruction and lymphedema surgery at PRMA Plastic Surgery in San Antonio, Texas.  PRMA is the only center in San Antonio, Texas and one of only a handful of centers worldwide to provide breast reconstruction on such a large scale. Our surgeons treat patients from across Texas and the US, as well as international patients.  We are proud to have a tremendous global reputation for breast reconstruction excellence.

There are many reconstructive breast surgeons in the United States. However, very few perform DIEP flap routinely due to the technical difficulty of the surgery. To date, our surgeons have performed thousands of microsurgical breast procedures. We are proud to perform over 700 DIEP surgeries every year. Patients are routinely welcomed from Texas, throughout the US, and across the World.

Please note that I, as Ticking Off Breast Cancer, do not accept responsibility for the content of the guest blogs. The information and content provided in all guest blogs is intended for information and educational purposes only and is not intended to substitute for professional medical advice. Please seek professional advice or speak to your medical team if you have any questions about the issues raised in this guest blog.

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