Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema

Abstract

Background The contribution of simultaneous breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap to the efficacy of vascularized groin lymph node transfer (LNT) for breast cancer-related lymphedema (BCRL) was investigated. Methods Patients were divided into two groups: the first group underwent groin LNT + DIEP flap surgery for simultaneous breast reconstruction (groin LNT + DIEP flap group) and the second group underwent groin LNT only (groin flap alone group). Patients with BCRL were evaluated based on indocyanine green lymphography findings. LNT was indicated only in advanced-stage BCRL cases, and groin nodes nourished by superficial circumflex iliac artery (SCIA) were used as donors. The side for the vascular pedicle(s) was decided based on our algorithm. In patients with pendulous breast, the flap was vertically transferred on the chest. Lymphatic function was assessed after LNT using imaging tests, and transferred lymph nodes were evaluated using ultrasonography. Results In this study, 27 patients with advanced-stage BCRL underwent LNT. Of them, 13 belonged to the groin LNT + DIEP flap group and 14 belonged to the groin flap alone group. Although reduction volume was not significantly different between the groups, the number of patients in whom lymphatic function was improved and the need for compression therapy could be reduced was significantly higher in the groin LNT + DIEP flap group than in the groin flap alone group. Conclusion When a patient with advanced-stage BCRL undergoes LNT based on SCIA, simultaneous breast reconstruction using DIEP flap may reduce the need for compression therapy.

Predesigned chimeric deep inferior epigastric perforator and inguinal lymph node flap for combined breast and lymphedema reconstruction: A comprehensive algorithmic approach

“… 12 Several donor sites have been suggested for this combined approach, e.g., the free abdominal-based flap combined with inguinal lymph nodes, the latissimus dorsi-based vascularized lymph node transfer, 23 or the gastroepiploic lymph node flap associated with the DIEP flap; 24 however, the chimeric flap coupling the inguinal lymph nodes to a DIEP or muscle-sparing transverse rectus abdominis myo-cutaneous (MS-TRAM) flap remains the mainstay for simultaneous breast and BCRL reconstruction in post-mastectomy patients. 13 , 15 , 16 , 17 , 25 , 26 …”

Surgical management of breast cancer-related lymphedema: a narrative review of contemporary practices

“…Akita et al evaluated the postoperative outcomes of patients with advanced-stage BCRL undergoing VLNT-DIEP flap (n=13) and groin-VLNT alone (n=14) ( 76 ). Overall, 33.3% of the patients had improvement of dermal backflow pattern after surgery (≥75% reduction of dermal backflow) and were able to entirely discontinue compression garments ( 76 ). The scores of upper extremity index were comparable between patients undergoing VLNT-DIEP flap versus VLNT alone (13.9±4.1 versus 13.2±1.5, P=0.75) ( 76 ).…”

Optimizing Outcomes in Lymphedema Reconstruction

“…Other studies have advocated for LVB alone when appropriate targets are available, but we assert that these patients are likely to gain additional benefit from simultaneous VLNT. [72][73][74] For patients who are poor candidates for LVB, VLNT alone or in combination with a debulking procedure is performed. Although some surgeons advocate debulking by means of liposuction before VLNT, we recommend debulking after VLNT and only if the desired volume reduction and symptomatic relief are not achieved with VLNT alone.…”