Where does subcutaneous lymph from the chest wall flow into after mastectomy?

Akita, Shinsuke; Yamaji, Yoshihisa; Tokumoto, Hideki; Tezuka, Takafumi; Ogata, Hideyuki; Kosaka, Kentaro; Kanai, Masahiko; Kuriyama, Masafumi; Mitsukawa, Nobuyuki

doi:10.1016/j.bjps.2021.03.112

Cited by 3 publications

(9 citation statements)

References 31 publications

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“…Prior reports have determined the axillary lymph nodes to be the main lymphatic drainage site of the ipsilateral chest with some studies showing alternate lymphatic drainage patterns. 2,3 We showed that variations in lymph flow patterns to the contralateral axilla and the inguinal lymph nodes are associated with lymphedema development in the trunk and arm.…”

Section: Discussionmentioning

confidence: 93%

“…T here is a growing recognition of truncal lymphedema following breast cancer treatment, however the field remains largely unstudied. [1][2][3] Truncal lymphedema patients suffer from lymphatic stasis in the soft tissue of the chest and abdomen resulting in fibrotic skin, swelling, and pain, which have been associated with increased infection rates and delayed reconstruction. 1,2 In order to develop effective treatment modalities, there is a need for improved anatomic studies of truncal lymphatics and lymph flow.…”

mentioning

confidence: 99%

“…[1][2][3] Truncal lymphedema patients suffer from lymphatic stasis in the soft tissue of the chest and abdomen resulting in fibrotic skin, swelling, and pain, which have been associated with increased infection rates and delayed reconstruction. 1,2 In order to develop effective treatment modalities, there is a need for improved anatomic studies of truncal lymphatics and lymph flow.…”

mentioning

confidence: 99%

“…6,[8][9][10][11] In the trunk, cadaveric and clinical studies have identified the ipsilateral axilla as the primary lymphatic drainage of the chest. 2,3 Alternate pathways of lymphatic flow have been observed to the inguinal lymph nodes and contralateral axilla, which may be associated with lymphedema development. 2 Previous investigations have also established the validated Pittsburgh Trunk Lymphedema Staging System (PTLSS), which characterizes the location and severity of dermal backflow in the chest and abdomen.…”

mentioning

confidence: 99%

“…2,3 Alternate pathways of lymphatic flow have been observed to the inguinal lymph nodes and contralateral axilla, which may be associated with lymphedema development. 2 Previous investigations have also established the validated Pittsburgh Trunk Lymphedema Staging System (PTLSS), which characterizes the location and severity of dermal backflow in the chest and abdomen. 1 This study aims to identify risk and protective factors for the development of truncal and upper extremity lymphedema after breast cancer treatment.…”

mentioning

confidence: 99%

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Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy

Mehta,

Sarrami,

Moroni

et al. 2024

Ann Plast Surg

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Background Anatomic and functional descriptions of trunk and breast lymphedema following breast cancer treatment are emerging as indicators of lymphatic dysfunction. Indocyanine green-lymphangiography has been instrumental in characterizing this dysfunction in the extremity and can be applied to other regions. Previous work has established a validated Pittsburgh Trunk Lymphedema Staging System to characterize such affected areas. This study aims to identify risk and protective factors for the development of truncal and upper extremity lymphedema using alternative lymphatic drainage, providing implications for medical and surgical treatment. Methods Patients undergoing revisional breast surgery with suspicion of upper extremity lymphedema between 12/2014 and 3/2020 were offered lymphangiography. The breast and lateral/anterior trunks were visualized and blindly evaluated for axillary and inguinal lymphatic flow. A linear-weighted Cohen's kappa statistic was calculated comparing alternative drainage evaluation. Binomial regression was used to compute relative risks (RRs). Significance was assessed at alpha = 0.05. Results Eighty-six sides (46 patients) were included. Twelve sides underwent no treatment and were considered controls. Eighty-eight percent of the noncontrols had alternative lymphatic flow to the ipsilateral axillae (64%), ipsilateral groins (57%), contralateral axillae (20.3%), and contralateral groins (9.3%). Cohen's kappa for alternative drainage was 0.631 ± 0.043. Ipsilateral axillary and contralateral inguinal drainage were associated with reduced risk of developing truncal lymphedema [RR 0.78, confidence interval (CI) 0.63–0.97, P = 0.04; RR 0.32, CI 0.13–0.79, P = 0.01, respectively]. Radiation therapy increased risk of truncal and upper extremity lymphedema (RR 3.69, CI 0.96–14.15, P = 0.02; RR 1.92, CI 1.09–3.39, P = 0.03, respectively). Contralateral axillary drainage and axillary lymph node dissection were associated with increased risk of upper extremity lymphedema (RR 4.25, CI 1.09–16.61, P = 0.01; RR 2.83, CI 1.23–6.52, P = 0.01, respectively). Conclusions Building upon previous work, this study shows risk and protective factors for the development of truncal and upper extremity lymphedema. Most prevalent alternative channels drain to the ipsilateral axilla and groin. Ipsilateral axillary and contralateral inguinal drainage were associated with reduced risk of truncal lymphedema. Patients with radiation, axillary dissection, and contralateral axillary drainage were associated with increased risk of upper extremity lymphedema. These findings have important clinical implications for postoperative manual lymphatic drainage and for determining eligibility for lymphovenous bypass surgery.

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy

Mehta,

Sarrami,

Moroni

et al. 2024

Ann Plast Surg

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Potential explanations for the reported lack of improvement in chest lymph circulation after vascularized lymph node transfer

Sakai

2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Parasitization of the pedicle: a rare form of TRAM flap recurrence

Binks,

Guo,

Sabanathan

et al. 2023

Journal of Surgical Case Reports

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Local recurrence after mastectomy and autologous breast reconstruction is uncommon and tends to occur predictably within the superficial tissues or at the chest wall. We present a unique case of breast cancer recurrence involving the superficial and deep tissues. By parasitizing the pedicle of a free transverse rectus abdominis myocutaneous flap pedicle, the tumour was seen to extend through the chest wall to the right pleura.

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Where does subcutaneous lymph from the chest wall flow into after mastectomy?

Cited by 3 publications

References 31 publications

Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy

Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy

Potential explanations for the reported lack of improvement in chest lymph circulation after vascularized lymph node transfer

Parasitization of the pedicle: a rare form of TRAM flap recurrence

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