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If you've been diagnosed with breast cancer, many advanced treatment options offer hope for a cure. Unfortunately, sometimes breast cancer treatment can cause other complications, like lymphedema. Lymphedema is a lifelong condition that causes painful swelling in the arm on the same side you underwent treatment. It can develop if lymph nodes are removed or injured during radiation therapy or surgery.
Up to 20 percent of women patients who undergo treatment for breast cancer eventually develop lymphedema. And up till now, there wasn't much we could do to address the root cause of the problem. Historically, lymphedema treatment options involved helping people deal with the symptoms and learn how to manage life with the condition.
Today, lymphedema surgery opens the door to many possibilities for patients with lymphedema to do things they couldn't do before. Whether you want to wear a fancy dress to an event or you want your wedding ring to fit back on your finger, there are a variety of surgical options available to treat secondary lymphedema.
Up to 20% of breast cancer survivors develop lymphedema. On the #MedStarBlog, reconstructive surgeon Dr. David Song shares how advanced surgery can restore quality of life for patients with the condition: https://bit.ly/3wGlIP1.
What is lymphedema?
Lymphedema is a condition that develops when lymph fluid accumulates in the body because it cannot adequately drain throughout the lymphatic vessels. When this happens, it can lead to persistent swelling in the areas where it builds up. Lymph contains white blood cells, which help the body fight infections and are part of the immune system. Lymph vessels carry lymph that drains from the body’s tissues and organs to lymph nodes. Lymph nodes filter lymph and produce more white blood cells.
There are two kinds of lymphedema: primary and secondary lymphedema. Primary lymphedema is a condition people are born with. Patients with breast cancer may be at risk for secondary lymphedema, which happens when lymph vessels are damaged or blocked because of another condition.
Lymph node removal during breast cancer surgery can increase your risk of the condition.
Breast cancer treatment may involve removing lymph nodes located in the axillary, or underarm. Even if these lymph nodes aren’t removed as part of a patient’s breast cancer surgery, they may still be damaged during a lumpectomy or mastectomy. Removed or damaged axillary lymph nodes can prevent lymph from draining properly from the arm, which causes it to swell. Patients who have had any of the following procedures to treat their breast cancer may be at risk for developing lymphedema if their treatment involved the axillary lymph nodes:
- Radiation therapy
- Simple or radical mastectomy
If left untreated, lymphedema can lead to bacterial or fungal infections of the skin. It can also carry additional risks, including loss of mobility and flexibility in the affected arm.
Sometimes lymphedema is easy to see. Other times, it’s difficult to notice right away. Watch for these lymphedema symptoms if you’ve had breast cancer surgery:
- Feeling like the arm or hand is too tight, heavy or full
- Pain or redness in the arm or hand
- Thickened skin in the arm or hand
- Tighter fit for shirts, watches or rings
Microsurgery can alleviate painful swelling caused by lymphedema.
People who have lymphedema may be able to manage the condition with conservative treatments, including:
- Compression bandages, pumps or sleeves
- Physical therapy
- Special massage techniques
But if the condition gets worse or doesn’t respond to these treatments, surgery may be a good option.
In the past, lymphedema surgery was limited to the removal of excess tissue and fluid in the arms. But modern techniques allow us to actually treat a patient’s lymphedema with surgery, rather than just addressing the symptoms. Our microsurgical procedures can help relieve the pain and swelling of lymphedema.
But if the condition gets worse or doesn’t respond to these treatments, surgery may be an effective solution.
In the past, lymphedema surgery was limited to removing excess tissue and fluid in the arms. But modern techniques allow us to actually treat a patient’s lymphedema with surgery rather than just addressing the symptoms. Our microsurgical procedures can help relieve the pain and swelling of lymphedema.
We offer two forms of lymphedema surgery: lymph node transfer and lymphovenous bypass. Both of these tend to be more helpful and effective for patients who are in the early stages of lymphedema, rather than patients who have had severe lymphedema for a long time. Because the procedures are microsurgical, they require specialized instruments and training. As one of the first in the region to offer these surgical treatments, we remain one of the most experienced teams treating lymphedema.
Vascularized lymph node transfer.
During lymph node transfer surgery, we take healthy lymph nodes from another part of the body and transplant them to the area of swelling in a patient with lymphedema. These healthy lymph nodes then can improve the drainage of lymph in the affected arm, thereby improving the swelling.
We normally take healthy lymph nodes from a patient’s groin. Our microsurgical techniques mean we only need to make tiny incisions on the hand, as well as an incision on the groin that’s easily hidden by underwear or a bikini. This procedure can also be done during breast reconstruction surgery, adding no additional recovery time.
Patients who live in the Washington, D.C., area stay in the hospital about 23 hours after surgery and go home. If a patient comes in from outside the region, they stay in the hospital for about two days. Then, they remain in the area (but not in the hospital) for a week and go home for care from their regular doctor.
In lymphovenous bypass surgery, we lower lymph buildup and pressure by connecting blocked lymph vessels to nearby veins. This reroutes the lymph through other channels to reduce swelling.
This is a minor outpatient procedure, meaning patients can have the surgery and go home the same day. Lymphovenous bypass only requires tiny incisions and involves very little blood loss.
Recovery after lymphedema surgery.
Before surgery, we will recommend that you meet with a certified lymphedema therapist to complete preoperative therapy. Participating in therapy four to six weeks before surgery will help to ensure the best results. After surgery, your care team will provide specific instructions, which may include the following guidelines:
During the first two weeks, you should:
- Avoid pressure to the incision site
- Avoid lifting, pushing, or pulling more than 10 pounds
After two weeks, you can resume:
- Lymphedema therapy (once drains have been removed)
- Manual lymphatic drainage
After four weeks, you can typically return to activity.
You can expect to see decreased swelling immediately after surgery. The arm may swell again in the future, but the swelling will go down once again. You will still need to take steps to manage the condition through:
- Regular exercise
- Massage therapy
- Maintaining a healthy body mass index (BMI)
- Infection prevention
Our surgeons are some of the only doctors on the East Coast to perform these procedures.
We were one of the first in the mid-Atlantic to offer these sophisticated surgeries, and we're training the next generation of reconstructive surgeons to treat lymphedema with these procedures.
At MedStar Health, our reconstructive surgeons are always looking for ways to help our patients achieve their goals. I think curing lymphedema is at the top of the list for every patient with lymphedema, and these surgeries can do that. But even if we can’t eliminate it completely in some cases, we can dramatically improve patients’ quality of life and help them manage the condition better.
Treating patients for lymphedema is one of the most rewarding things I do as a surgeon. I love getting to help my patients reduce or even eliminate painful swelling and improve their mobility. And I love seeing the nearly immediate positive benefits these surgeries can have on my patients’ lives. I’m hopeful that we’ll be able to help more patients enjoy life without the pain and discomfort of lymphedema.