Patients suffering from breast cancer related lymphedema (BCRL) can be treated with a simultaneous DIEP flap, vascularized inguinal lymph node transfer (VLNT), and lymphovenous anastomosis
(LVA) for aesthetic breast reconstruction and lymphedema
in one operation.
Comparison of prospectively followed free flap breast reconstruction with VLNT and LVA to retrospective cohort of free flap breast reconstruction with VLNT alone.
Thirty-three patients (average age: 53.4 years, average BMI: 33.2 kg/m2
) underwent DIEP flap reconstruction with VLNT and LVA compared to 21 (average age: 52.0 years, average BMI: 35.3 kg/m2
) undergoing free flap with VLNT alone. There were no significant differences in demographics, adjuvant chemotherapy or radiation therapy. The average numbers of nodes removed during the axillary dissection was also equivalent (21.2 vs. 21.4 nodes). An average of 2 LVA per patient were performed (range: 1-4) in the combined cohort, and all patients (100%) reported a subjective improvement in symptoms compared to 81.0% of patients receiving only the VLNT (p=0.019). Perometer measurements demonstrated significant reduction between the two groups at early time points (3 months: 40.7% vs. 20.0%, p=0.037) and 6 months (57.0% vs. 44.5%, p=0.043), but was not statistically significant at 12 months (60.4% vs. 57.8%, p=0.43).
This is the first prospective study demonstrating the safety and efficacy of a combined DIEP flap with VLNT and LVA which may be superior to performing a breast free flap with a lymph node transfer alone. Future larger studies are necessary to corroborate the present findings.