Combined microsurgical breast reconstruction and lymphoedema surgery: a systematic review of surgical techniques

As physiological lymphoedema surgery increases in popularity, a focus on combining autologous breast reconstruction and lymphoedema surgery is emerging. The current research bed however is limited by scarcity and heterogeneity of surgical technique. This review aims to amalgamate the existing literature to provide recommendations for surgical technique and perioperative imaging in order to optimise combined reconstruction and lymphoedema surgery.

A PRISMA adherent systematic review was undertaken by extensively searching Pubmed and Embase using MeSH terms and key words. Title and abstract screening and full text review were undertaken by two independent reviewers. Data was extracted into excel and any quantitative methods were undertaken on R studio.

Sixteen total studies were included in this review. Four major reconstruction modalities were explored: DIEP/msTRAM + groin vascularised lymph node transfer, the MD Anderson Cancer Centre ‘BRILIANT’ technique, DIEP/msTRAM + gastroepiploic lymph node transfer and Omental Fat Augmented Free Flap + gastroepiploic lymph node transfer. The use of perioperative imaging such as CT Angiography and intraoperative reverse lymph node mapping and perfusion angiography is discussed. Vessel choice for primary anastomosis was largely the internal mammary artery and vein, where the serratus branch of the thoracodorsal artery and vein were used for secondary anastomosis. Finally, reports that most patients experienced symptomatic lymphoedema relief with some patients experiencing a reduction in arm circumference are also explored.

Combined microsurgical breast reconstruction and lymphoedema surgery can be achieved with many techniques and is safe and moderately effective in the current literature.

Level of Evidence: Not ratable