Breast and Genital Lymphedema

Lymphaticovenous anastomosis (LVA) is a low-invasive procedure, and we recommend LVA for thoracic or genital lymphedema as the first choice. As the lymphatic flow around the breast or the genital region is complicated and varies among patients, it is essential to recognize the responsible lymphatic vessels for the lymphedema. If preoperative examination is performed appropriately, the procedure of LVA is the same as that in the extremities. In the preoperative examinations, multi-lymphosome indocyanine green (ICG) lymphography and lymphatic ultrasound play an important role. In lymphatic ultrasound, index of Doppler, Cross, Uncollapsible, Parallel, and Superficial fascia (D-CUPS), which we proposed previously, is useful to detect the lymphatic vessels. In this section, we explain our experience and the strategy for breast and genital lymphedema, including the anatomy, preoperative examinations, resection of genital-acquired lymphangiectasia (GAL), and procedure of LVA.