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Microvascular Breast Reconstruction and Lymph Node Transfer for Postmastectomy Lymphedema Patients

Saaristo, Anne M. MD, PhD; Niemi, Tarja S. MD; Viitanen, Tiina P. MD; Tervala, Tomi V. MD; Hartiala, Pauliina MD, PhD; Suominen, Erkki A. MD, PhD

doi: 10.1097/SLA.0b013e3182426757
Surgical Technique

Objective: Postoperative lymphedema after breast cancer surgery is a challenging problem. Recently, a novel microvascular lymph node transfer technique provided a fresh hope for patients with lymphedema. We aimed to combine this new method with the standard breast reconstruction.

Methods: During 2008–2010, we performed free lower abdominal flap breast reconstruction in 87 patients. For all patients with lymphedema symptoms (n = 9), we used a modified lower abdominal reconstruction flap containing lymph nodes and lymphatic vessels surrounding the superficial circumflex vessel pedicle. Operation time, donor site morbidity, and postoperative recovery between the 2 groups (lymphedema breast reconstruction and breast reconstruction) were compared. The effect on the postoperative lymphatic vessel function was examined.

Results: The average operation time was 426 minutes in the lymphedema breast reconstruction group and 391 minutes in the breast reconstruction group. The postoperative abdominal seroma formation was increased in patients with lymphedema. Postoperative lymphoscintigraphy demonstrated at least some improvement in lymphatic vessel function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased in 7 of 9 patients. Physiotherapy and compression was no longer needed in 3 of 9 patients. Importantly, we found that human lymph nodes express high levels of endogenous lymphatic vessel growth factors. Transfer of the lymph nodes and the resulting endogenous growth factor expression may thereby induce the regrowth of lymphatic network in the axilla. No edema problems were detected in the lymph node donor area.

Conclusion: Simultaneous breast and lymphatic reconstruction is an ideal option for patients who suffer from lymphedema after mastectomy and axillary dissection.

In this article, we demonstrate that lymph node transfer can be safely combined with standard breast reconstruction. A majority of treated patients showed improvement in lymphatic drainage. We recommend this reconstruction option for patients who suffer from lymphedema after mastectomy.

From the Department of Plastic Surgery, Turku University Central Hospital, Turku, Finland.

Reprints: Anne M. Saaristo, MD, PhD, Department of Plastic Surgery, Turku University Central Hospital, PL 52, Kiinamyllynkatu 4–8, Turku 20251, Finland. E-mail: Anne.Saaristo@helsinki.fi.

Disclosure: This study was supported by the Academy of Finland, the Turku University Foundation, Special Governmental Funding (EVO) allocated to Turku University Central Hospital, the Paavo and Eila Salonen Foundation, the Ida Montini Foundation, the Aarne and Aili Turunen Foundation, and the Emil Aaltonen Foundation. Dr. Saaristo is a member of the board of directors of OY Lx Therapies Ltd.

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