Vascularized lymph node transfer is the latest surgical option for the treatment of lymphedema. The procedure was first described several years ago and has continued to evolve since then. It is now gaining popularity for the treatment of arm lymphedema in breast cancer survivors that do not respond to conservative (non-surgical) therapy. The results have been quite exciting.
In the case of arm lymphedema caused by breast cancer surgery or radiation, a vascularized lymph node transfer moves healthy lymph nodes , usually from the upper-outer groin, to the underarm area (axilla). These healthy nodes compensate for the lymph nodes removed or damaged by the breast cancer treatment.
The lymph nodes from the upper-outer groin can be transplanted connected to a DIEP flap at the same time as breast reconstruction, or as a separate piece of tissue if DIEP flap breast reconstruction is not being performed at the same time. These lymph nodes are more superficial than the deeper groin lymph nodes that are important for lymphatic drainage of the leg.
Lymph node transfer is not the only surgical option for lymphedema . Other surgical options include soft tissue resection, liposuction, and lymphatico-venous or lymphatico-venule anastomoses (connecting the lymphatic system to the venous system to encourage drainage).
Of all the procedures described to treat lymphedema, vascularized lymph node transfer is showing the most exciting results in terms of decreasing swelling, preventing infections and reducing the need for compression therapy. Patients can experience improvement in their symptoms very quickly after surgery though it can take several months in some cases.
As with all surgery, there are risks too. In addition to the risks of any surgery (bleeding, infection, wound healing issues), the lymph nodes may not survive and the lymphedema can worsen because of further scarring created by the surgery. There is also a risk of creating leg swelling if deep groin lymph nodes are taken. Thankfully, the risk of these complications is very low.
Only patients that have exhausted all conservative therapy by certified lymphedema specialists are considered candidates for vascularized lymph node transfer.