Axillary lymph node dissection and sentinel lymph node biopsies are important oncologic tools used to assess the metastasis in breast cancer patients. However these procedures can compromise the lymphatic system, which takes excess fluid from tissue and returns it to blood vessels. This helps your immune system fight infections.
Compromised lymphatic function can cause a chronic swelling called lymphedema. This condition is uncomfortable and may inhibit immune function, making a person more susceptible to infection.
Lymphatic surgery aims to improve drainage to reduce swelling in the arm and improve immune function.
Types of Lymphedema Surgery Procedures
Vascularized Lymph Node Transfers (Autologous Lymph Node Transfers)
- Contrast dye is injected under the skin to map lymphatic channels
- While performed as preventative procedure, the lymphatic channels are connected to small veins in the axilla during axillary lymph node dissection, preventing lymphedema
- In patients looking to correct lymphedema, a surgeon uses small incisions in the skin on the arm to identify the lymphatic channel and neighboring small veins
- Lymphatic channels are attached to the small veins using microsurgical techniques
Vascularized Lymph Node Transfer
- A surgeon identifies a recipient site within the arm that has lymphedema
- Lymph nodes from another part of the body—like the back or groin— are selected and prepared
- Lymph nodes are transferred with an artery and a vein to keep the nodes alive
- Blood vessels in the lymph nodes are connected to blood vessels in the arm using microsurgical techniques
Risks & Benefits
These procedures carry a risk of infection. In some cases, swelling in the arm worsens. Lymphedema can develop in the lymph node donor site as a result of vascularized lymph node transfer. Recovery time varies by surgery and tends to be shorter in patients who undergo lymphovenous bypass.
Patients who undergo successful procedures benefit from reduced swelling. In some cases, lymphedema surgery reduces or eliminates the need to use a compression garment. It may also improve immune function in the affected limb.