Immediate Lymphatic Reconstruction

Breast cancer-related lymphedema (BCRL) is a disfiguring disease. Despite advancements in surgical and conservative approaches to treatment, there remains no reliable cure, necessitating a preventative strategy. Immediate lymphatic reconstruction (ILR) is a surgical procedure targeted at preventing BCRL. In this procedure, transected lymphatic channels are anastomosed to nearby axillary venous tributaries. A body of literature demonstrating the effectiveness of ILR for preventing BCRL continues to expand. Over time, multiple technical advancements have been made, including the utilization of various lymphatic-specific dyes for visualization and facilitation of lymphovenous anastomoses, as well as implementation of a lower extremity vein graft to reduce venous-related complications. Despite promising evidence for ILR, medical insurance coverage for this procedure and a limited number of surgeons performing lymphatic microsurgery prevent patient access to ILR. In the future, a greater understanding of risk factors for BCRL, including lymphatic anatomy of the upper extremity, will be critical for stratifying individual risk of BCRL and thereby aid in identifying those with the greatest need for ILR.