Surgical Management of Lymphedema: Prophylactic and Therapeutic Operations

Lymphedema is a chronic limb swelling caused by lymphatic dysfunction and is currently incurable. Breast cancer–related lymphedema (BCRL) affects up to 5 million Americans and occurs in one-third of breast cancer survivors following axillary lymph node dissection. Compression remains the mainstay of therapy. Surgical management of BCRL includes excisional procedures to remove excess tissue and physiologic procedures to attempt to improve fluid retention in the limb. The purpose of this review is to highlight surgical management strategies for preventing and treating breast cancer–related lymphedema.

Immediate lymphatic reconstruction (ILR) is a microsurgical technique that anastomoses disrupted axillary lymphatic vessels to nearby veins at the time of axillary lymph node dissection (ALND) and has been reported to reduce lymphedema rates from 30 to 4–12%.

Postsurgical lymphedema remains incurable. Surgical management of lymphedema includes excisional procedures and physiologic procedures using microsurgical technique. Immediate lymphatic reconstruction has emerged as a prophylactic strategy to prevent lymphedema in breast cancer patients.