Controversial Microsurgery May Ease Lymphedema, but Long-Term Results Aren’t Certain

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Lymphedema is swelling of the arm, hand, or chest wall caused by a build-up of lymph fluid in those tissues after breast cancer surgery. Radiation therapy and chemotherapy can add to the risk of lymphedema.

An uncommon type of surgery, called lymphaticovenular bypass, sometimes is done to treat lymphedema. A very small study found that lymphaticovenular bypass can ease lymphedema in some women, but it's unclear how long the benefits last. Besides the uncertainty about how long the results last, lymphaticonvenular bypass is controversial because it may make lymphedema worse if not done by a specially trained, very experienced surgeon.

As blood flows through the body's tissues, a small amount of clear fluid -- lymph fluid -- naturally forms and bathes the tissues. Lymph fluid moves through tissues via a network of channels called lymphatic vessels. Normal muscle action helps keep lymph fluid levels balanced by moving the fluid through the lymphatic vessels and back into the bloodstream so fluid doesn't build up and cause swelling. Lymph nodes, such as the ones in your armpit, act like relay stations in the lymphatic vessel network.

During surgery to remove breast cancer, some of the lymphatic vessels in the chest wall and armpit area may have to be cut. (Lymphatic vessels are more likely to be cut if lymph nodes are removed.) If some lymph vessels are cut, there may be fewer channels to drain the lymph fluid from nearby tissues. Lymph fluid then can build up in the arm, hand, or chest wall area.

About 40% of women develop some degree of lymphedema after breast cancer surgery. Lymphedema can improve slowly or even go away over time. Still, lymphedema is more likely to be a problem for women who've had more extensive surgery and had lymph nodes removed. A number of non-surgical techniques can help reduce the risk of lymphedema, including compression garments and massage.

In this very small study, researchers looked at the results of 20 women who chose to have lymphaticovenular bypass surgery to treat lymphedema that had lasted for an average of about 5 years after breast cancer surgery. The surgery was done at the M.D. Anderson Cancer Center in Houston. During lymphaticovenular bypass, which is considered microsurgery, three or four lymphatic vessels in the arm are connected directly to veins (blood vessels that move blood to the heart). The goal of this rerouting is to increase the flow of lymphatic fluid out of the arm and ease the lymphedema. This surgical treatment for lymphedema is rare, but is more common in Asia and Europe than it is in the United States.

Researchers assessed lymphedema improvement by measuring the size (volume) of the affected arm before and after lymphaticovenular bypass. They also asked the women how the arm felt -- whether it felt lighter or softer, for example.

After lymphaticovenular bypass, the women's arms were smaller, but by the end of the first year after surgery, some of the benefits seemed to be lost. Affected arm size decreased:

  • 29% 1 month after surgery
  • 33% 3 months after surgery
  • 39% 6 months after surgery
  • 25% 1 year after surgery

Many of the women reported that their arms felt lighter and softer after the microsurgery and none of the women had significant complications or had the lymphedema get worse.

Lymphaticovenular bypass surgery is difficult to do and requires special surgical training. This may be one reason why it's not a common lymphedema treatment. While the women in this study did receive some benefit from the surgery, the decrease in arm size didn't last and none of the women were considered cured of lymphedema. More, larger studies are needed to see if the results last over time, as well to figure out if the surgery works for a variety of women.

If you have severe lymphedema and non-surgical treatments haven't helped, you may be considering lymphaticovenular bypass surgery. Make sure that the surgeon doing the surgery (usually a plastic surgeon) has a lot of experience and has had good success with the procedure.

You can learn more about lymphedema and the non-surgical steps you can take to avoid, minimize, and manage it in the Breastcancer.org Lymphedema section.

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