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Surgical Management of Lymphedema: Prophylactic and Therapeutic Operations

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Abstract

Purpose of Review

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.

Recent Findings

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%.

Summary

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.

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Funding

This work was supported by the US National Institutes of Health (NIH) grants NIH K08HL167164 and R21AR082600 and the Department of Defense W81XWH2110135 to AHH.

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Authors and Affiliations

  1. Division of Plastic Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 232, Indianapolis, IN, 46202, USA

    Shahnur Ahmed & Aladdin H. Hassanein

  2. Division of Surgical Oncology, Indiana University School of Medicine, 11645 N Illinois St, Indianapolis, IN, 46202, USA

    Folasade O. Imeokparia

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  1. Shahnur Ahmed
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  2. Folasade O. Imeokparia
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  3. Aladdin H. Hassanein
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Contributions

S.A., F.O.I., and A.H.H. wrote the main manuscript text, and S.A. prepared Figs. 1 and 2. All authors reviewed the manuscript.

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Correspondence to Aladdin H. Hassanein.

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Ahmed, S., Imeokparia, F.O. & Hassanein, A.H. Surgical Management of Lymphedema: Prophylactic and Therapeutic Operations. Curr Breast Cancer Rep (2024). https://doi.org/10.1007/s12609-024-00543-4

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