Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction

Abstract

Microsurgical breast reconstruction did not improve the outcome of BCRL. Improvements in BCRL were better for lymphatic microsurgery than complete decongestive therapy. Moreover, vascularized lymph node flap transfer provided greater improvements in the BCRL than lymphovenous anastomosis.

Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes

“…Furthermore, previous studies suggested that immediate breast reconstruction could reduce the risk of breast cancer‐related lymphedema (BCRL), and the delayed breast reconstruction may release lymphedema symptoms of the lymphedematous arm . However, recently, the senior author's group clearly demonstrated that the outcome of BCRL is not affected by the microsurgical breast reconstruction itself in a study investigating the outcome of lymphatic microsurgery procedures with or without breast reconstruction …”

“…After that, the senior author's group shed some light reporting anatomic studies and clinical application of the groin and submental lymph node flaps transferred to the distal affected extremity . Recent studies have evaluated the positive effects of VLN transfer in the setting of lymphedema and have shown significantly better results for the patients in which the native lymphatic ducts are no longer available when compared to conservative treatments or LVA . A meta‐analysis investigated the outcomes of VLN flaps in comparison to LVA for the treatment of lymphedema .…”

“…A meta‐analysis investigated the outcomes of VLN flaps in comparison to LVA for the treatment of lymphedema . Although LVA and VLN transfer were both effective for short‐term outcomes in terms of circumferential reduction rate, the VLN transfer group had significantly better long‐term outcomes in terms of greater likelihood of discontinuing the compression garments . Currently, many international groups are applying lymphatic microsurgery procedures to treat lymphedema, but standard treatment guidelines remain debatable.…”

“…[7][8][9] Recent studies have evaluated the positive effects of VLN transfer in the setting of lymphedema and have shown significantly better results for the patients in which the native lymphatic ducts are no longer available when compared to conservative treatments or LVA. 16 A meta-analysis investigated the outcomes of VLN flaps in comparison to LVA for the treatment of lymphedema. 17 Although LVA and VLN transfer were both effective for short-term outcomes in terms of circumferential reduction rate, the VLN transfer group had significantly better long-term outcomes in terms of greater likelihood of discontinuing the compression garments.…”

“…17 Although LVA and VLN transfer were both effective for short-term outcomes in terms of circumferential reduction rate, the VLN transfer group had significantly better long-term outcomes in terms of greater likelihood of discontinuing the compression garments. 16 Currently, many international groups are applying lymphatic microsurgery procedures to treat lymphedema, but standard treatment guidelines remain debatable. Controversy regarding patient selection criteria, type, and timing of surgery, selection of donor site, recipient sites of VLN flaps (ie, proximal or distal), and postoperative evaluation of the outcome are still pieces of a puzzle that need to be clarified.…”