How surgery can improve the lives of patients with lymphedema

by David H. Song, MD, Washington Regional Chief, Plastic Surgery
October 3, 2017

There are many options available to patients for treating breast cancer. Unfortunately, a significant portion of patients will face the complication of lymphedema after their treatment. About 20 percent of patients diagnosed with breast cancer will develop lymphedema.

About 20% of patients diagnosed with #breastcancer will develop #lymphedema. via @MedStarWHC

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Historically, there hasn’t been much doctors could do for lymphedema. Our treatment options focused on helping people deal with symptoms and adjust to the realities of having this condition, not addressing and eliminating the cause. But we now have surgeries that treat the root cause of lymphedema, not just symptom control.

Lymphedema surgery can open up many possibilities for patients to do things they weren’t able to before. If you want to wear a fancy dress to an event, or if you want to play basketball or a game of tennis, you might not have to wear a compression sleeve anymore.

LISTEN: Dr. Song discusses lymphedema surgery further on the Medical Intel podcast.

I’m one of the only doctors in Washington, D.C., and the East Coast who offers these advanced surgeries, and I’m happy to talk with patients and their family members about their potential benefits.

Request an appointment with me through our secure online form, or contact me at (202) 444-8751 so we can discuss whether lymphedema surgery is right for you.

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What is lymphedema?

Lymphedema is a condition in which lymph accumulates in the body, leading to swelling in the areas where it builds up. Lymph contains white blood cells, which help the body fight infections, as part of the immune system. Lymph vessels carry lymph that drains from the body’s tissues and organs to lymph nodes. Lymph nodes filter lymph and produce more white blood cells.

There are two kinds of lymphedema: primary lymphedema and secondary lymphedema. Primary lymphedema is a condition people are born with. Patients who have breast cancer may be at risk for secondary lymphedema, which happens when lymph vessels are damaged or blocked because of another condition.

Treatment for breast cancer may involve the removal of the axillary, or underarm, lymph nodes. Even if these lymph nodes aren’t removed as part of a patient’s breast cancer surgery, they may still be damaged during the procedure. Removed or damaged axillary lymph nodes can keep lymph from draining properly from the arm, which causes the arm to swell.

Patients who have had any of the following procedures to treat their breast cancer may be at risk for lymphedema if their treatment involved the axillary lymph nodes:

  • Lumpectomy
  • Radiation therapy
  • Simple or radical mastectomy

If left untreated, lymphedema can lead to bacterial or fungal infections of the skin. Loss of mobility and flexibility in the affected arm are additional risks the condition carries.

Sometimes the swelling of lymphedema is easy to see. But it’s sometimes more difficult to notice right away. Watch for these lymphedema symptoms if you’ve had breast cancer surgery:

  • Feeling like the arm or hand is too tight, heavy or full
  • Pain or redness in the arm or hand
  • Thickened skin in the arm or hand
  • Tighter fit for shirts, watches or rings

How we treat lymphedema

People who have lymphedema may be able to manage the condition with treatments such as:

  • Compression bandages, pumps or sleeves
  • Physical therapy
  • Special massage techniques

But if the condition gets worse or doesn’t respond to these treatments, surgery may be a good option.

In the past, lymphedema surgery was limited to the removal of excess tissue and fluid in the arms. But modern techniques allow us to actually treat a patient’s lymphedema with surgery, rather than just addressing the symptoms. Our microsurgical procedures can help relieve the pain and swelling of lymphedema.

Our microsurgical procedures can help relieve the pain and swelling of #lymphedema. via @MedStarWHC

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We offer two forms of lymphedema surgery: lymph node transfer and lymphovenous bypass. Both of these tend to be more helpful and effective for patients who are in the early stages of lymphedema, rather than patients who have had lymphedema for a long time.

Lymph node transfer

In lymph node transfer surgery, we take healthy lymph nodes from another part of the body and transplant them to the area of swelling in a patient with lymphedema. These healthy lymph nodes then can improve the drainage of lymph in the patient’s arm and reduce swelling.

We normally take healthy lymph nodes from a patient’s groin. Our microsurgical techniques mean we only need to make tiny incisions on the hand, as well as an incision on the groin that’s easily hidden by underwear or a bikini.

Patients who live in the Washington, D.C., area stay in the hospital about 23 hours after surgery and go home. If a patient comes in from outside the region, they stay in the hospital for about two days, stay in the area but not in the hospital for a week, and then go home for care from their regular doctor.

Lymphovenous bypass

In lymphovenous bypass surgery, we lower lymph buildup and pressure by connecting blocked lymph vessels to nearby veins. This lets lymph drain away from the swollen arm to reduce swelling.

This is an outpatient procedure, meaning patients can have the surgery and go home the same day. Lymphovenous bypass only requires tiny incisions and involves very little blood loss.

Achieving goals for treating lymphedema

Before I came to MedStar Health, I was chief of plastic surgery and associate dean at the University of Chicago, where I built a lymphedema surgery program from scratch. When I left, that program was the busiest in the country for the surgical treatment of lymphedema. I plan to do the same at MedStar Washington Hospital Center and MedStar Georgetown University Hospital.

Our main focus is on how we can help our patients achieve their goals. Curing lymphedema is, I think, at the top of the list for every patient with lymphedema, and these surgeries can do that. But even if we can’t cure it completely in some cases, we can dramatically improve patients’ quality of life and help them manage the condition better.

Treating patients for lymphedema is one of the most rewarding things I do as a surgeon. I love getting to help my patients reduce or even eliminate painful swelling and improve their mobility. And I love seeing the nearly immediate positive benefits these surgeries can have on my patients’ lives. I’m hopeful that we’ll be able to help more patients enjoy life without the pain and discomfort of lymphedema.

Category: Healthy Living, Innovations, Medical Intel     Tags: breast cancerDr. David Songlymphedemalymphedema surgerylymphedema symptomslymphedema treatmentwhat is lymphedema