Omental vascularized lymph node transplant for the treatment of breast lymphedema: A case report

Abstract

Breast lymphedema is a type of breast cancer related lymphedema that leads to significant discomfort and negative impact on body image. Conservative therapy and lymphovenous bypass have been previously described as possible treatment methods for breast lymphedema, however, a unified approach to treatment is lacking. The current report describes a case of breast lymphedema successfully treated with vascularized lymph node transfer (VLNT) after failed attempt at management with conservative therapy. The patient is a 48-year-old female with right-sided breast cancer who underwent breast conservation therapy in 2015 and subsequently developed pain and swelling of the right breast. The diagnosis of breast lymphedema was supported by clinical evaluation as well as MRI, lymphoscintigraphy, and lymphography. In consultation with a breast surgeon, breast lymphedema was determined not to be an indication for mastectomy. The patient was offered and underwent an omental VLNT to the right breast. A 20 cm segment of omentum with associated gastroepiploic vessels and lymph nodes was harvested, transferred to the right axilla and gastroepiploic vessels were anastomosed to the recipient thoracodorsal vessels.

Surgical Treatment of Breast Lymphedema: A Distinct Pathology With Unique Challenges

“…The published literature on surgical treatment of BL consists of 7 reports describing 8 patients. [9][10][11][12][13][14][15] Of the 7 patients who underwent LVB, only 3 had received WBI. [10][11][12] The remaining report describes a patient who received WBI, who had no LVB targets on presentation, and who was not offered mastectomy because of disagreement on the part of breast surgical oncology.…”

“…Vascularized lymph node transfer has been demonstrated as effective. 15 Vascularized lymph vessel transfer could be applied in the same fashion. Nanofibrillar collagen scaffolds 26 could be used to encourage regeneration of dermal lymphatics within radiated tissue, especially in patients with intact axillary nodal basins that can create a growth factor concentration gradient along the scaffold.…”

“…The published literature on surgical treatment of BL consists of 7 reports describing 8 patients 9–15 . Of the 7 patients who underwent LVB, only 3 had received WBI 10–12 .…”

“…The few case reports of surgical BL treatment have focused almost exclusively on LVB, with no reported cases of debulking 9–15 . We present our experience with BL, including LVB, excision, and VLNT, to highlight unique features and considerations that may warrant a different approach to treatment.…”

“…8 The few case reports of surgical BL treatment have focused almost exclusively on LVB, with no reported cases of debulking. [9][10][11][12][13][14][15] We present our experience with BL, including LVB, excision, and VLNT, to highlight unique features and considerations that may warrant a different approach to treatment. Furthermore, we include the first report of mastectomy for BL and the first reported breast reconstruction with abdominal free flap and inguinal VLNT for BL.…”