Cancer Lymphedema

Dr. Brock Lanier, MD, FACS   |   OncoPlastic Surgery in Newport Beach

What Causes Lymphedema?

Lymphedema is a condition with swelling of the arm or the leg. It is typically caused by an abnormal build-up of lymph fluid. In a normal arm or leg, this lymph fluid naturally drains out through lymphatic channels.

Some cancer surgeries can damage these lymphatic channels if lymph nodes need to be removed. Radiation treatment can also damage the lymphatics.

When the lymphatic system is injured, lymph fluid accumulates in the arm or leg, which causes swelling, tissue fibrosis/scarring, and other complications. This is lymphedema.

Lymphedema: introduction and non-surgical management

At our medical practice we get a lot of questions about lymphedema, what causes it, and what non-surgical treatments are available.

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  • Lymphaticovenous bypass (or LVB) is a surgical procedure designed to address lymphedema by restoring lymphatic drainage. The injured lymphatic channels are bypassed or connected to nearby tiny veins. This restores the natural flow of lymphatic fluid, allowing it to drain away. By creating this new pathway, LVB targets the root cause of lymphedema: the blockage of lymphatic drainage. The incisions required for this minimally invasive surgery are relatively small, typically about two finger-widths, as the lymphatic vessels and veins are located just beneath the skin's surface, avoiding deeper muscle or structural involvement.

  • Vascularized lymph node transfer (or VLNTx) is a surgical procedure that involves transplanting healthy lymph nodes from a donor site to the affected arm or leg. This technique aims to introduce working lymph nodes to the area where the lymphatic system is compromised. The transplanted nodes absorb excess lymphatic fluid and returning it to its normal circulation. VLNT is a more complex surgery than LVB, requiring incisions at both the donor area and the recipient site. It typically is a longer surgery with a longer recovery compared to LVB.

  • Minimally invasive tissue excision (or MITE), is also called suction-assisted protein lipectomy (or SAPL). It aims to reduce arm or leg size by removing excess scar tissue (fibrosis). Unlike LVB and VLNT, which improve lymphatic drainage, MITE directly addresses the accumulated fibrotic/scar tissue that causes limb enlargement. This procedure is performed to restore a more normal size when other treatments haven't achieved adequate volume reduction.

Lymphatic Surgery: exploring the different options

Surgery for lymphedema is best when it has not improved and isn’t well managed with non-operative options. Explore the different surgical approaches.

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