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Lymphaticovenular Bypass for Lymphedema Management in Breast Cancer Patients: A Prospective Study

Chang, David W. M.D.

Plastic & Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - pp 752-758
doi: 10.1097/PRS.0b013e3181e5f6a9
Breast: Original Articles
Discussion

Background: Lymphedema is a common and debilitating condition. Management options for lymphedema are limited and controversial. The purpose of this prospective study was to provide a preliminary analysis of lymphaticovenular bypass for the treatment of upper limb lymphedema in breast cancer patients.

Methods: Twenty patients with upper extremity lymphedema secondary to treatment of breast cancer underwent lymphaticovenular bypass using a “supermicrosurgical” approach. The mean age of the patients was 54 years, 16 patients had received preoperative radiation therapy, and all patients had received axillary lymph node dissection. The mean duration of lymphedema was 4.8 years, and the mean volume differential of the lymphedematous arm compared with the unaffected arm was 34 percent. Evaluation included qualitative assessment and quantitative volumetric analysis before surgery and at 1 month, 3 months, 6 months, and 1 year after the procedure.

Results: The mean number of bypasses performed per patient was 3.5 (range, two to five), and the size of bypasses ranged from 0.3 to 0.8 mm. The mean operative time was 3.3 hours (range, 2 to 5 hours). Hospital stay was less than 24 hours for all patients. The mean follow-up time was 18 months. Nineteen patients (95 percent) reported symptom improvement following surgery, and 13 patients had quantitative improvement. The mean volume differential reduction was 29 percent at 1 month, 36 percent at 3 months, 39 percent at 6 months, and 35 percent at 1 year. No patients experienced postoperative complications or lymphedema exacerbation.

Conclusions: Lymphaticovenular bypass may effectively reduce the severity of lymphedema in breast cancer patients. Long-term analysis is needed.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication January 7, 2010; accepted February 16, 2010.

Presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, in Rancho Mirage, California, May 21 through 24, 2009.

Disclosure: The author has no financial interest in any of the products, devices, or drugs mentioned in this article.

David W. Chang, M.D. Department of Plastic Surgery University of Texas M. D. Anderson Cancer Center 1515 Holcombe Boulevard Houston, Texas 77030-4009 dchang@mdanderson.org

©2010American Society of Plastic Surgeons