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Annals of Surgical Oncology

, Volume 22, Issue 9, pp 2919–2924 | Cite as

An Algorithmic Approach to Simultaneous Vascularized Lymph Node Transfer with Microvascular Breast Reconstruction

  • Alexander T. Nguyen
  • Edward I. Chang
  • Hiroo Suami
  • David W. Chang
Reconstructive Oncology

Abstract

Background

Lymphedema is a common, progressive, and often debilitating condition that can occur after breast cancer treatment. Preliminary reports on vascularized lymph node transfer (VLNT) have been promising. We propose an algorithmic approach to simultaneous VLNT with microvascular breast reconstruction (MBR) and provide early results.

Methods

All patients who underwent simultaneous VLNT with MBR were included. Postoperative evaluation was performed at standardized time points and included qualitative assessment and quantitative volumetric analysis.

Results

Between 2011 and 2013, 29 consecutive patients with refractory lymphedema secondary to breast cancer treatment underwent simultaneous VLNT with MBR. Mean follow-up was 11 months. On average, patients had experienced 3.3 years of lymphedema symptoms with 21 % increased volume in the affected arm compared with the unaffected arm. Using our algorithmic approach, all patients underwent successful breast reconstruction. There were no flap losses, and no patients developed donor site lymphedema. Six patients (21 %) experienced donor site wound complications that resolved with conservative measures; 23 patients (79 %) reported sustained symptomatic improvement after reconstruction. The mean volume differential volumes improved to 20, 19, 14, and 10 % at 1, 3, 6, and 12 months after reconstruction, respectively.

Conclusions

Our algorithm provides a reliable approach to optimizing simultaneous abdominal free flap breast reconstruction and VLNT and demonstrates promising results. Long-term studies are warranted to further delineate and improve the safety and efficacy of lymph node transfers.

Keywords

Lymphedema Breast Reconstruction Recipient Vessel Abdominal Flap Deep Inferior Epigastric Perforator Flap 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This manuscript was partly supported by the NIH/NCI under Award number P30CA016672.

Disclosures

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Alexander T. Nguyen
    • 1
  • Edward I. Chang
    • 1
  • Hiroo Suami
    • 1
  • David W. Chang
    • 2
  1. 1.Department of Plastic SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Section of Plastic and Reconstructive SurgeryThe University of Chicago Medicine & Biological SciencesChicagoUSA

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