Breast Cancer-Related Lymphedema: A Review of Management and Innovative Surgical Techniques A Review of Management and Innovative Surgical Techniques
Main Article Content
Abstract
Lymphedema is one of the most feared complications of breast cancer treatment. The objective of this article is to review the basic workup, staging, and diagnostic criteria for lymphedema and to discuss non-surgical and surgical treatments, with a focus on breast-cancer related lymphedema. Non-surgical treatment consists of intensive physical therapy including manual lymphatic drainage via massage, daily compression wraps, and exercises to prevent scarring and increase mobility. Surgical intervention is considered when non-surgical treatment is ineffective or more recently as a preventive measure. Surgical interventions, used once lymphedema has developed, include 1) lympho-venous bypass, which is the anastomosis of lymphatic vessels distal to the site of dermal backflow to neighboring venules to shunt lymphatic drainage away from the area of lymphatic injury; 2) vascularized lymph node transplant, in which lymph nodes are harvested from a donor site with their supporting artery and vein and transferred to the affected recipient site; and 3) debulking procedures including liposuction and direct excision. Preventive surgical interventions include 1) lymphatic microsurgical preventive healing approach, known as LYMPHA, which also utilizes lympho-venous anastomoses but at the time of lymph node dissection to anastomose lymphatic channels transected during lymph node dissection with adjacent veins to preserve lymphatic drainage of the arm; and 2) axillary reverse mapping, which involves tracer or dye injection within the ipsilateral arm before axillary surgery so that the breast surgeons are able to delineate nodal drainage and therefore attempt to spare nodes specific to arm tissue provided they are not the sentinel lymph node. Patient selection is critical for these procedures, and requires a multi-disciplinary approach.
Article Details
How to Cite
NEWSOM, Keeley D et al.
Breast Cancer-Related Lymphedema: A Review of Management and Innovative Surgical Techniques.
Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3245>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.18103/mra.v10i10.3245.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Scallan J, Huxley VH, Korthuis RJ. Capillary Fluid Exchange: Regulation, Functions, and Pathology. Colloquium Series on Integrated Systems Physiology: From Molecule to Function. 2010;2(1):1-94.
4. Dayan JH, Ly CL, Kataru RP, Mehrara BJ. Lymphedema: Pathogenesis and Novel Therapies. Annu Rev Med. 2018;69:263-276.
5. Brouillard P, Boon L, Vikkula M. Genetics of lymphatic anomalies. J Clin Invest. 2014;124(3):898-904.
6. Smeltzer DM, Stickler GB, Schirger A. Primary lymphedema in children and adolescents: a follow-up study and review. Pediatrics.
7. Wheeler ES, Chan V, Wassman R, Rimoin DL, Lesavoy MA. Familial lymphedema praecox: Meige’s disease. Plast Reconstr Surg. 1981;67(3):362-364.
8. Kissin MW, Della Rovere GQ, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. British Journal of Surgery. 1986;73(7):580-584.
9. Laredo J, Lee BB. Lymphedema. In: Mowatt-Larssen E, Desai SS, Dua A, Shortell CEK, eds. Phlebology, Vein Surgery and Ultrasonography: Diagnosis and Management of Venous Disease. Springer International Publishing; 2014:327-339.
10. Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018;7(4):379-403.
11. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500-515.
12. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116(22):5138-5149.
13. Mehrara BJ, Greene AK. Lymphedema and obesity: is there a link? Plast Reconstr Surg. 2014;134(1):154e-160e.
14. McLaughlin SA, Brunelle CL, Taghian A. Breast Cancer–Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment. J Clin Oncol. 2020;38(20):2341-2350.
15. Gowda AU, Nie J, Mets E, Alperovich M, Avraham T. Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction. Ann Plast Surg. 2021;87(3):248-252.
16. Fish ML, Grover R, Schwarz GS. Quality-of-Life Outcomes in Surgical vs Nonsurgical Treatment of Breast Cancer-Related Lymphedema: A Systematic Review. JAMA Surg. 2020;155(6):513-519.
17. Dupuy A, Benchikhi H, Roujeau JC, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ. 1999;318(7198):1591-1594.
18. Grada AA, Phillips TJ. Lymphedema: Pathophysiology and clinical manifestations. Journal of the American Academy of Dermatology. 2017;77(6):1009-1020.
19. Passik SD, McDonald MV. Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer. 1998;83(S12B):2817-2820.
20. Shih YCT, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27(12):2007-2014.
21. Finkelstein ER, Ha M, Hanwright P, et al. A Critical Analysis of American Insurance Coverage for Imaging and Surgical Treatment of Lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2022;0(0).
22. Finkelstein ER, Ha M, Hanwright P, et al. A review of American insurance coverage and criteria for conservative management of lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2022;10(4):929-936.
23. Suami H, Chang DW, Yamada K, Kimata Y. Use of indocyanine green fluorescent lymphography for evaluating dynamic lymphatic status. Plast Reconstr Surg. 2011;127(3):74e-76e.
24. Neligan PC, Kung TA, Maki JH. MR lymphangiography in the treatment of lymphedema. Journal of Surgical Oncology. 2017;115(1):18-22.
25. Maki JH, Neligan PC, Briller N, Mitsumori LM, Wilson GJ. Dark Blood Magnetic Resonance Lymphangiography Using Dual-Agent Relaxivity Contrast (DARC-MRL): A Novel Method Combining Gadolinium and Iron Contrast Agents. Curr Probl Diagn Radiol. 2016;45(3):174-179.
26. Narushima M, Yamamoto T, Ogata F, Yoshimatsu H, Mihara M, Koshima I. Indocyanine Green Lymphography Findings in Limb Lymphedema. J Reconstr Microsurg. 2016;32(1):72-79.
27. Soga S, Onishi F, Mikoshi A, Okuda S, Jinzaki M, Shinmoto H. Lower limb lymphedema staging based on magnetic resonance lymphangiography. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2022;10(2):445-453.e3.
28. Mikami T, Hosono M, Yabuki Y, et al. Classification of lymphoscintigraphy and relevance to surgical indication for lymphaticovenous anastomosis in upper limb lymphedema. Lymphology. 2011;44(4):155-167.
29. Greene AK, Goss JA. Diagnosis and Staging of Lymphedema. Semin Plast Surg. 2018;32(1):12-16.
30. Kim G, Smith MP, Donohoe KJ, Johnson AR, Singhal D, Tsai LL. MRI staging of upper extremity secondary lymphedema: correlation with clinical measurements. Eur Radiol. 2020;30(8):4686-4694.
31. Schaverien MV, Coroneos CJ. Surgical Treatment of Lymphedema. Plast Reconstr Surg. 2019;144(3):738-758.
32. Földi E. The treatment of lymphedema. Cancer. 1998;83(S12B):2833-2834.
33. Douglass J, Graves P, Gordon S. Self-Care for Management of Secondary Lymphedema: A Systematic Review. PLOS Neglected Tropical Diseases. 2016;10(6):e0004740.
34. Javid SH, Anderson BO. Mounting Evidence Against Complex Decongestive Therapy As a First-Line Treatment for Early Lymphedema. JCO. 2013;31(30):3737-3738.
35. Dayes IS, Whelan TJ, Julian JA, et al. Randomized Trial of Decongestive Lymphatic Therapy for the Treatment of Lymphedema in Women With Breast Cancer. JCO. 2013;31(30):3758-3763.
36. Noh S, Hwang JH, Yoon TH, Chang HJ, Chu IH, Kim JH. Limb Differences in the Therapeutic Effects of Complex Decongestive Therapy on Edema, Quality of Life, and Satisfaction in Lymphedema Patients. Ann Rehabil Med. 2015;39(3):347-359.
37. Oshnari LA, Hosseini SA, Haghighat S, Zadeh SH. The Effect of Complete Decongestive Therapy on Edema Volume Reduction and Pain in Women With Post Breast Surgery Lymph Edema. Int J Cancer Manag. 2016;9(2).
38. Buragadda S, Alhusaini AA, Melam GR, Arora N. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema. Journal of Physical Therapy Science. 2015;27(9):2743-2748.
39. Melam GR, Buragadda S, Alhusaini AA, Arora N. Effect of complete decongestive therapy and home program on health- related quality of life in post mastectomy lymphedema patients. BMC Women’s Health. 2016;16(1):23.
40. Sezgin Ozcan D, Dalyan M, Unsal Delialioglu S, Duzlu U, Polat CS, Koseoglu BF. Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-Related Lymphedema. Lymphatic Research and Biology. 2018;16(5):446-452.
41. Sanal-Toprak C, Ozsoy-Unubol T, Bahar-Ozdemir Y, Akyuz G. The efficacy of intermittent pneumatic compression as a substitute for manual lymphatic drainage in complete decongestive therapy in the treatment of breast cancer related lymphedema. Lymphology. 2019;52(2):82-91.
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