Immediate Lymphatic Reconstruction: An Overview and Current Evidence

Breast-cancer related lymphedema is a significant source of morbidity in patients undergoing axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) is a procedure that has been developed to re-route lymphatic channels into the venous system to decrease the incidence of lymphedema in these patients. We have developed a comprehensive lymphedema program at our institution through which we routinely offer ILR for patients undergoing ALND.

We have found several tactics that have contributed to our ILR program. These include building a multidisciplinary team, consistent pre-operative and post-operative evaluation, intra-operative techniques for maximizing success, and protocoled management of patients who do develop signs or symptoms of lymphedema. We also review the current literature in ILR and find that evidence shows improvement in lymphedema rates after ILR.

Here we outline a comprehensive strategy for both development of a lymphedema program and management patients undergoing ALND and ILR. We find that the current evidence overwhelmingly supports performing this procedure in the setting of ALND.