Two surgical procedures to treat lymphedema that are only available in a handful of U.S. hospitals.

Lymphedema can be a painful and frustrating side effect of breast cancer treatment. Too often patient suffer in silence and have few treatment options at their disposal.

Beginning in early 2017, our surgeons will offer two new surgical procedures -- vascularized lymph node transfer and lymphatic venous anastomosis (LVA) -- to treat lymphedema. We will be one of only a handful of hospitals in the United States to offer these surgeries.

In addition, we will soon establish a lymphedema program and clinic. This one-stop shop for lymphedema care will provide access to experts who can discuss treatment options, including surgery, compression garments, medical intervention, and physical therapy.

While there’s no cure for lymphedema, our surgeons and certified lymphedema therapists can offer solutions to help you return to daily activities with less discomfort.

  • What is lymphedema?

    Lymphedema is a build-up of lymph fluid in the fatty tissue just under the skin. The condition results in swelling, usually in the arms and legs. It can occur when lymph nodes are removed or damaged during breast surgery or radiation treatment. Lymphedema prevents fluid from draining properly, which can cause discomfort, limited movement, and infections that return over and over again.

    Lymphedema symptoms can begin months or even years after treatment. If you’ve had breast surgery or treatment, periodically examine your body in the mirror. If you notice changes in size, shape, or skin color of your arms or legs, seek treatment right away.

    Signs and symptoms to watch for include:

    • Aching, tingling, or discomfort
    • Clothes and jewelry not fitting properly (pant legs, shirt sleeves, watches, or rings)
    • Feeling full or heavy in the arms or legs
    • Restricted movement or flexibility
    • Swelling in the chest, arms, or legs
    • Texture or color changes in the skin (feeling hard or looking red)

    Our breast cancer surgeons seek the least invasive treatment option to eliminate cancer -- and decrease uncomfortable side effects when possible. This includes procedures such as sentinel node biopsy. Surgeons remove fewer lymph nodes with this approach, which reduces the risk of lymphedema.

  • Lymphedema surgery

    Most hospitals focus only on caring for and managing the side effects of lymphedema, such as swelling and pain. We also take a holistic approach. Two new surgical procedures allow us to also treat the condition itself: vascularized lymph node transfer and lymphatic venous anastomosis (LVA).

    These procedures have been available in Europe since the early 2000s, but only gained interest in the United States around 2013 after research showed benefits. These techniques will not cure lymphedema, but may offer longer-term relief from symptoms for some patients.

    Vascularized lymph node transfer

    This is a lymph node transplant. The surgeon takes one or more lymph nodes and blood vessels from one part of the body and moves them to the area where lymph nodes were removed during cancer surgery. The transplanted lymph nodes then will take over the function of the removed lymph nodes.

    Lymphatic venous anastomosis (LVA)

    This procedure also is known as lymph node bypass. The surgeon creates a connection between the lymphatic vessels and veins to facilitate drainage of the lymphatic fluid into the circulatory system. Basically, we create a detour for the fluid.

    What to expect before, during, and after lymphedema surgery

    • Before surgery: The doctor injects green dye in the hands or feet and uses imaging equipment to assess current lymphatic drainage. We’ll also use ultrasound to examine the lymph nodes. A nuclear medicine study may be necessary to map the lymph nodes.
    • During surgery: These surgeries can last eight to 10 hours. You will be placed under general anesthesia.
    • After surgery: If the new blood vessel connections are working properly, you can go home after three days. You will need two weeks’ recovery before returning to work or normal daily activities. You also will need to wear a compression garment to keep the fluid moving properly in your arm or leg. If the new blood vessel connections do not work, another surgery may be required soon after the first.

    Possible lymphedema surgery side effects

    You can expect some scarring at the sites where lymph nodes are taken and placed, or where vessels are connected to veins. In vascularized lymph node transfer, there is potential to develop lymphedema at the site where we remove lymph nodes for transplant.

    Because these procedures are not a cure for lymphedema, you may still need to wear compression garments and practice other good habits to control potential side effects.

    Who is a candidate for lymphedema surgery?

    Right now, we only offer these procedures to patients who have early-stage lymphedema caused by the removal of lymph nodes due to cancer. Candidates must be compliant with wearing compression stockings and participating in physical therapy.

    In the future, we hope to use these techniques as a preventive measure by performing them at the time of the initial breast cancer surgery on patients at high risk for developing lymphedema. High-risk candidates would include those who:

    • Are 55 or older
    • Are obese
    • Need all lymph nodes removed
    • Will undergo radiation after breast cancer surgery
  • Other lymphedema treatments

    With proper lymphedema management, you can reduce swelling and control pain.

    Options that can help you manage the condition include:

    • Compression garments: These are fitted sleeves that can prevent and reduce swelling by moving lymph fluid from the arm or leg back into the body. Talk with your lymphedema therapist about proper fitting and when to wear them.
    • Exercise: Using your muscles encourages lymph fluid drainage. Work with a health professional to design an exercise plan.
    • Massage: Therapeutic massage can encourage lymph fluid to flow out of the arm or leg. Work with someone specially trained in the technique.
  • Reduce your lymphedema risk

    It’s unclear whether lymphedema is preventable. But there are steps you can take to lower your risk and reduce its impact.

    Your body sends extra fluid and white blood cells throughout the body to fight infection. If lymph nodes are missing, it’s more difficult for the body to move this fluid.

    Follow these hygiene and skin care tips to avoid infection:

    • When you need a vaccination, blood drawn, or an IV inserted, use the unaffected arm if possible. Tell the provider that you’re at risk for lymphedema.
    • Use moisturizer to avoid cracked skin, especially in the winter.
    • Wear protectives gloves with sleeves when doing yard work or household chores that require harsh chemicals or steel wool. Use a thimble when you sew.
    • Clean and protect cuts, scratches, insect bites, hangnails, or torn cuticles.
    • Use a clean razor when you shave.

    Other ways to lower your lymphedema risk:

    • Get regular medical check-ups. Report changes in size, color, or skin condition of the affected limb to your cancer care team.
    • Maintain a healthy weight. Obese women are at higher risk for lymphedema.
    • Watch for cellulitis. This is an infection in the tissues just under the skin that can lead lymphedema or make it worse. Signs of cellulitis include redness, warmth, pain, fever, or flu-like symptoms. In some cases, you may need antibiotics to control it.
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