Vascular Lymph Node Transfer

Vascular Lymph Node Transfer is a surgery to help cure lymphedema. Lymphedema is a condition that can be caused by different treatments for breast cancer, namely axillary node dissections (removing lymph nodes from the armpit that may have cancer cells in them) and radiation therapy (sometimes used to kill cancer cells in the armpit). Lymphatic vessels carry fluid from the arm to the “filters” of the body called “lymph nodes.” When these lymphatic vessels are disrupted either by surgery or radiation, the fluid sometimes doesn’t have anywhere to drain, and scar tissue where these lymph nodes used to be forms and can compress nerves and vessels in the area that result in symptoms of pain, numbess, swelling, heaviness, weakness, and overall decreased function of the affected arm. Lymphedema can also cause recurrent infections of the arm called “cellulitis” and in some cases may even cause cancer of the lymphatic channels called “lymphangiosarcoma.”

The treatment for lymphedema has been quite limited until recently. The only options for treatment of upper extremity lymphedema have been physical therapy, compression therapy and massage therapy, which have been used to help treat the symptoms, however never cure the disease. There have been many proposed surgical treatments that have not been shown to be effective in reducing the lymphedema and/or the symptoms. A surgical procedure that has been used for decades in Europe, has recently been introduced by a handful of microsurgery trained Plastic Surgeons in the United States. This is called a Vascularized Lymph Node Transfer, in which 1-3 healthy lymph nodes are harvested and detached from an unaffected site (such as the groin) and microsurgically placed into the area where the lymph nodes had been removed and the damage was done. Using microsurgical techniques, the surgical team can connect the blood supply to those lymph nodes to blood vessels in the diseased are, and allow new lymphatic channels to grown.

This procedure has shown promising long-term results with reduction of swelling in the arm, and an overall decrease if not complete resolution of lymphedema symptoms. Lymphatic studies after transfer of lymph nodes has shown growth of new vessels and active function of the transferred lymph nodes. Sometimes, the reduction in swelling can take up to 2 years to achieve maximal results.

Considerations

Similar to any surgical procedure, there are potential complications that can occur. Infection, bleeding, blood clots, fluid collections, unsightly scars, and even lymphedema of the area where the lymph nodes had been harvested are all possible. The benefits far outweigh the risks with regard to this procedure for patients whom are ideal candidates. You will meet with Dr. Loghmanee and Dr. Cerio several times before your surgery and undergo a complete pre-operative evaluation to assure you are optimized and are an ideal surgical candidate prior to proceeding with surgery.

Am I a good candidate for Vascular Lymph Node Transfer?

One or more of the following may indicate you are a good candidate for vascular lymph node transfer;

  • You recently had breast cancer and have been diagnosed with lymphedema as a result
  • All scar tissue has fully matured and post operative edema has completely settled from your breast surgery (usually at least 6 months)
  • You are currently not receiving chemotherapy
  • You have persistent debilitating pain in the arm/armpit
  • You have had a number of infections due to lymphedema

Dr. Cerio and Dr. Loghmanee will conduct an examination and discuss with you the vascularized lymph node transfer procedure and expected outcome. You must come prepared to discuss your full medical history, including any medical conditions, previous surgeries or treatments, family history of breast cancer, drug allergies, current medications, and use of alcohol, tobacco or illegal substances. If you use tobacco, you are not a candidate for any elective procedure as the risks double for those who use tobacco. We are happy to assist you in tobacco cessation and once the blood is nicotine free for 4 weeks, you may be considered for surgery.

New Procedure: Vascularized lymph node transfer is a relatively new procedure here in the United States. This means that not everyone may have the same results, however the early evidence is promising and much more successful than the older techniques, and certainly more so than non-operative treatment.

Vascular Lymph Node Transfer Surgery and Recovery

Vascularized lymph node transfer is an inpatient surgery that is performed with general anesthesia and usually takes between 4-6 hours to perform depending on the amount of scar tissue you have, your extent of disease and your particular anatomy. The procedure can be combined with procedures like DIEP-FLAP  for delayed breast reconstruction and treatment of lymphedema at the same time. You will be given detailed information from Dr. Cerio and Dr. Loghmanee detailing normal symptoms, signs of complications and instructions for recovery. You should be able to walk and be up and about immediately following surgery. The incisions and placements of the lymph nodes will be tender to the touch for the first few days, and you must not lift, pull or push anything and not engage in any strenuous activity for at least six weeks. Dressings will be removed within several days. Stitches are usually absorbable and disappear by the first few weeks. Swelling and discoloration may occur but resolve within about a month. Dr. Loghmanee and Dr. Cerio will recommend they follow you closely both in the hospital and in the office to evaluate your healing process. As always, its important to follow doctor’s orders for the best outcome.