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Microsurgery for Primary Prevention of Lymphedema Following Surgery for Breast Cancer

October 15, 2019

Health Problem: Lymphedema refers to the swelling that occurs due to the accumulation of protein-rich fluids in tissue experiencing inadequate lymphatic drainage. One of the most common causes of secondary lymphedema are treatments for breast cancer, including axillary lymph node dissection, mastectomy, lumpectomy, and axillary radiation therapy. Lymphedema is associated with significant morbidity, including loss of limb function, discomfort, and disfigurement. As breast cancer treatments advance and survival rates posttreatment increase, prevention of the sequelae of treatment, including lymphedema, are receiving more consideration. 

Technology Description: The lymphatic microsurgical preventive healing approach (LYMPHA) procedure consists of performing lymphaticovenous anastomosis or lymphaticovenous bypass at the time of breast cancer treatment. Patients are injected with either an indocyanine green or patent blue dye in the upper arm of the limb expected to be affected during treatment. The dye injection allows for mapping of the lymphatic channels for identification for bypass or anastomosis. Lymphatic reconstructive microsurgery restores lymphatic flow via direct anastomosis or bypass which diverts lymph flow to a vein in the area.  

Controversy: Lymphedema is a common, chronic, and debilitating consequence of breast cancer treatment. Preventive measures taken can potentially improve patient outcomes and reduce comorbidities. Current preventive measures are conservative and rely on patient compliance. Microsurgical techniques have emerged for the prevention and treatment of lymphedema; however, the effectiveness and safety of the procedures are not known.

Key Questions:

  • Is microsurgery effective in preventing breast cancer–related lymphedema?
  • Is microsurgery safe for the prevention of breast cancer–related lymphedema?
  • How does microsurgery compare with no preventive microsurgery for the prevention of breast cancer–related lymphedema?
  • Have definitive patient selection criteria been established for microsurgery for the prevention of breast cancer–related lymphedema?