Microsurgery Offers New Hope for Breast Cancer Survivors with Lymphedema
Women with breast cancer who have lymphedema in their upper arm experienced reduced fluid in the swollen arm by up to 39 percent after undergoing a super-microsurgical technique known as lymphaticovenular bypass, report researchers at The University of Texas M. D. Anderson Cancer Center. The results from the prospective analysis, presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, suggest another option for women with breast cancer who are considering ways to manage lymphedema, a common and debilitating condition following surgery and/or radiation therapy for breast cancer.
Lymphedema results when the lymph nodes are removed or blocked due to treatment and lymph fluid accumulates causing chronic swelling in the upper arm. There is no cure or preventive measure for lymphedema, and it is difficult to manage. According to the National Cancer Institute, 25 to 30 percent of women who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema.
Researchers evaluated 20 women with breast cancer with stage II and III treatment- related lymphedema of the upper arm who underwent a lymphaticovenular bypass. Due to lymphedema, the women’s affected arms were an average of 34 percent larger compared to the unaffected arm prior to the surgery. Of these 20 women, 19 reported initial significant clinical improvement following the procedure.
“Surgical techniques [to reduce lymphedema] have been limited and therefore have been met with skepticism by surgeons, making it extremely important to determine which new techniques promise to bring real benefits to patients,” says lead author on the study David W. Chang, MD, professor in the department of Plastic Surgery and director of the Plastic Surgery Clinic at M. D. Anderson.
In lymphaticovenular bypass surgery, surgeons use tiny microsurgical tools to make two to three small incisions measuring an inch or less in the person’s arm. Lymphatic fluid is then redirected to microscopic vessels to promote drainage and alleviate lymphedema.
Dr. Chang notes that while most effective when completed in earlier stages before the affected arm is fibrotic, almost anyone with breast cancer who has lymphedema stage I, II, or III is a candidate. Though breast cancer was the focus of this study, the surgery can also be performed on people who have lymphedema in the leg resulting from cancers involving pelvic regions. Long-term follow-up is necessary to determine if the procedure continues to promote drainage after one year.
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This article was originally published in Coping® with Cancer magazine, May/June 2009.