Innovative surgical treatment of peripheral lymphedema after breast cancer surgery
In advanced countries, 98% of upper extremity lymphedema (UEL) are secondary to breast cancer treatments. Nevertheless this disease is quite common, it has been usually neglected and underestimated due to the scarce knowledge about the lymphatic system and the unavailability of effective treatments. As consequence, breast cancer patients are usually not well instructed about the risk of this disease and once UEL is diagnosed they are usually not follow-up by doctors but send for consultation to physical therapist only. The aim of this paper is to provide the status of art of diagnosis and innovative microsurgical treatment of UEL according to the experience of three centers, which provide those treatments as standard-of-care. Different diagnostic procedure can be employed to assess patients affected by lymphedema. Preoperative evaluation of residual lymphatic channel function will guide the therapeutical approach toward conservative, surgical or combined treatment as well as will guide the surgeon on offering lymphaticovenous anastomosis (LVA) versus lymph node flap (LNF) transfer. Microsurgical physiologic procedures are gaining widespread popularity, as they are able to improve lymphedema. LVA should be preferred over LNF transfer when residual lymphatic channels to bypass can be identified preoperatively, because when properly planned and performed, LVA is a less invasive surgery than LNF with higher success rate if good channel can be found. LNF should be reserved to patients with lymphedema refractory to LVA or as first choice when no suitable residual lymphatic channels can be identified preoperatively. Perioperative physical therapy is integral part of the treatment in order to boost the effect of microsurgical treatment.