Arch Hand Microsurg.  2021 Dec;26(4):298-302. 10.12790/ahm.21.0115.

Prevention of Breast Cancer-Related Lymphedema Using the Lymphatic Microsurgical Preventive Healing Approach: A Case Report

• Park MS
• Yoon JA
• Lee JW
• Kim JH

• KMID: 2522629
• DOI: http://doi.org/10.12790/ahm.21.0115

Abstract

Breast cancer-related lymphedema is a major complication of breast cancer surgery. The lymphatic microsurgical preventive healing approach, a surgical technique that can prevent breast cancer-related lymphedema, creates a lymphovenous bypass between the damaged axillary lymphatics during axillary lymph node dissection and the axillary vein. We report a case using the unilateral lymphatic microsurgical preventive healing approach in a patient with bilateral breast cancer. A 58-year-old woman diagnosed with bilateral invasive ductal carcinoma underwent a bilateral nipple-sparing mastectomy. The lymphatic microsurgical preventive healing approach was performed on the left side after axillary lymph node dissection; the lymphatic microsurgical preventive healing approach was not performed after axillary sentinel lymph node biopsy on the right side. Six months after the surgery, MD Anderson Cancer Center stage 2 lymphedema was observed in the lymphography images of the right arm, where the lymphatic microsurgical preventive healing approach had not been performed.

Keyword

Breast neoplasms; Lymphovenous anastomosis; Microsurgery; Secondary lymphedema

Figure

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  Fig. 1. (A) Photo of a 58-year-old female patient and (B) lymphoscintigraphy were taken preoperatively. Images were acquired 1 hour after administration of the radiotracer and show uptake at bilateral axillary nodes.

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  Fig. 2. Indocyanine green (ICG) lymphography images taken (A) preoperatively and (B) 6 months after breast cancer surgery show MD Anderson Cancer Center ICG stage 2 lymphedema in the right medial upper arm where axillary sentinel lymph node biopsy was performed. Dermal backflow is not observed in the left arm where lymphatic microsurgical preventive healing approach was performed after axillary lymph node dissection.

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  Fig. 3. During lymphatic microsurgical preventive healing approach, lymphovenous end-to-end anastomosis was performed between the axillary lymphatics (red arrow) and a collateral branch of the axillary vein (green arrow).

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