Some small studies have looked at whether surgery may be helpful in cases where particularly aggressive or advanced lymphedema doesn’t respond to other treatments. Although some early results are promising, surgery is considered experimental and isn’t widely available. If you have severe lymphedema that is not responding to treatment, you might consider talking with your lymphedema therapist about taking part in a clinical trial of surgery for lymphedema, if one is offered in your area.
Examples of surgery for lymphedema include:
- Liposuction: The body has a tendency to deposit fat in areas of the arm that are affected by lymphedema. A Swedish surgeon named Dr. Hakan Brorson was the first to discover that severe, non-pitting lymphedema (swelling that doesn’t indent when you push on it with your finger) contains a great deal of fatty tissue. By using liposuction to remove this tissue, he found that he could reduce the volume of the arm significantly. This doesn’t cure the lymphedema, but it can get the arm down to a size the patient would then have to maintain with bandaging at first, followed by wearing a compression sleeve during the day and using other forms of compression at night. Patients also need to follow all of the self-care guidelines for reducing risk of lymphedema flare-ups. A special note: Any plastic surgeon who performs liposuction isn’t necessarily qualified to offer liposuction for arm lymphedema.
- Lymph node transplant or transfer surgery: In this approach, the surgeon "harvests" lymph nodes and their attached blood vessels from another area of the body — such as the abdomen or groin — and then connects them to the lymph vessels and blood vessels under the arm. Another technique involves implanting the nodes into the wrist of the arm affected by lymphedema. Some small, early studies have found that the procedure can offer relief from severe swelling, heaviness in the limb, and infections, although it doesn’t cure the lymphedema. There is some concern that the procedure actually could cause lymphedema in the other area of the body from which the lymph nodes were taken.
- Lymphovenous anastomoses: This procedure uses microsurgery to build tiny bridges between the lymphatic vessels and the veins, so that the lymph fluid has a new pathway out of the arm. However, it hasn’t been proven effective in the small research studies available.
Keep in mind that surgery is viewed as an option of last resort for severe lymphedema that does not respond to treatment. Most people with lymphedema would not be considered candidates for surgery. Very few surgeons are qualified to offer these procedures, and you would need to investigate the experience of any surgeon you are considering. You can ask how many times he or she has performed surgery for breast cancer-related lymphedema and also ask to speak with some former patients. Although surgery may help reduce the volume of the arm, it will be essential to maintain those results with other treatments, such as compression sleeves and self care.
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