Surgical rehabilitation of women with upper limb postmastectomy lymphedema

Abstract

This study highlights the key aspects of the diagnosis of postmastectomy edema of the upper limb. Clinical examination that allows the diagnosis of lymphedema with a high degree of accuracy should be enhanced with lymphoscintigraphy and fluorescent lymphography to establish the diagnosis and predict the outcome of potential surgical intervention. We share our experience with lymphography in women with breast cancer and upper limb postmastectomy edema and various surgical interventions for lymphedema. In stage 2 lymphedema and ineffective therapy, microsurgical intervention (lymphovenous anastomosis) should be performed if indicated on the basis of lymphoscintigraphy and/ or fluorescent lymphography. Upper limb liposuction is recommended in stage 3–4 lymphedema and ineffective conservative treatment or lack of stable results. Water-jet assisted liposuction has established its efficacy based on the data of various authors and our findings, i.e., lymphedema reduced by 70–100% over 1–5 years of follow-up. KEYWORDS: breast cancer, lymphedema, water-jet assisted liposuction, long-term outcomes, lymphatic outflow patterns. FOR CITATION: Ermoshchenkova M.V., Myasnikova M.O., Zikiryakhodzhaev A.D., Galkin V.N., Startseva O.I., Reshetov I.V., Berestok T.S. Surgical rehabilitation of women with upper limb postmastectomy lymphedema. Russian Medical Inquiry. 2023;7(6):372–382 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-6.