Vascularized Lymph Node Transfer for Lymphedema

Vascularized lymph node transfer is the latest surgical option for the treatment of lymphedema. The procedure was first described several years ago and has continued to evolve since then. It is now gaining popularity for the treatment of arm lymphedema in breast cancer survivors that do not respond to conservative (non-surgical) therapy. The results have been quite exciting.


In the case of arm lymphedema caused by breast cancer surgery or radiation, a vascularized lymph node transfer moves healthy lymph nodes, usually from the upper-outer groin, to the underarm area (axilla). These healthy nodes compensate for the lymph nodes removed or damaged by the breast cancer treatment.

The lymph nodes from the upper-outer groin can be transplanted connected to a DIEP flap at the same time as breast reconstruction, or as a separate piece of tissue if DIEP flap breast reconstruction is not being performed at the same time. These lymph nodes are more superficial than the deeper groin lymph nodes that are important for lymphatic drainage of the leg.


Lymph node transfer is not the only surgical option for lymphedema. Other surgical options include soft tissue resection, liposuction, and lymphatico-venous or lymphatico-venule anastomoses (connecting the lymphatic system to the venous system to encourage drainage).

Of all the procedures described to treat lymphedema, vascularized lymph node transfer is showing the most exciting results in terms of decreasing swelling, preventing infections and reducing the need for compression therapy. Patients can experience improvement in their symptoms very quickly after surgery though it can take several months in some cases.

As with all surgery, there are risks too. In addition to the risks of any surgery (bleeding, infection, wound healing issues), the lymph nodes may not survive and the lymphedema can worsen because of further scarring created by the surgery. There is also a risk of creating leg swelling if deep groin lymph nodes are taken. Thankfully, the risk of these complications is very low.

Only patients that have exhausted all conservative therapy by certified lymphedema specialists are considered candidates for vascularized lymph node transfer.

Unfortunately, most insurance companies still consider the procedure experimental and do not currently cover the cost of lymph node transfer.

I hope this info helps.

Dr C

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Dr C is a board certified plastic surgeon and microsurgeon specializing in state-of-the-art breast reconstruction. In-Network for most US insurance plans. Patients welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options.

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Dieting reduces lymphedema after breast cancer

By David Douglas

NEW YORK (Reuters Health) - Weight loss appears to be an effective way to reduce breast cancer-associated lymphedema of the arm, according to UK researchers.

Lymphedema is common, chronic condition that often develops after breast surgery, in which excess fluid collects in the lymph nodes and vessels in the armpit. Treatment for this condition has usually "centered on skin care, external support and compression, exercise and movement and simple lymphatic drainage," lead investigator Dr. Clare Shaw told Reuters Health.
"This is the first time that weight reduction has been shown to influence the size of a lymphedematous arm," the researcher points out.

Shaw of the Royal Marsden National Health Service Foundation Trust, London, and colleagues note that obesity is a risk factor for lymphedema of the arm as well as for poor response to treatment.

To investigate whether weight reduction might benefit in these patients, the researchers studied 21 obese women with breast cancer-related lymphedema. Their average body mass index (BMI) was 32. BMI is the ratio of height to weight used to estimate if individuals are overweight or underweight. People with a BMI of 30 or greater are considered obesity.

The patients were randomly assigned to receive specific dietary advice aimed at cutting out 1,000 kcal per day or to receive an information booklet on healthy eating.

After 12 weeks, the intervention group had lost an average of 3.3 kg (7.3 lbs), their BMI was reduced by an average of 1.3, and excess arm volume fell from 25 percent to 15 percent. There were no changes in weight or in arm volume in the control group.

"Weight management should become an integral part of the management of breast cancer-related lymphedema," concluded Shaw. Overweight patients should be given information on the potential benefits of weight reduction and support to help them achieve it.

SOURCE: Cancer, October 15, 2007.

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