What is lymphedema?
Lymph nodes are small glands that clear wastes, bacteria, and other substances from the body’s tissues. Lymph nodes are sometimes removed during cancer surgery or damaged by radiation treatment. When this happens, a condition called lymphedema can occur. Lymphedema prevents the body from properly draining lymphatic fluid, causing swelling, pain and increased risk of infection.
Lymphedema occurs in up to 20% of women receiving axillary node dissection for breast cancer treatment. For these patients, lymphedema most often occurs in the arm on the side of the body affected by breast cancer.
In the past, lymphedema symptoms were treated through drainage and various compression techniques. However, two cutting-edge microsurgical approaches can now provide longer-term relief for some patients: lymph node transfer and lymphovenous bypass.
MedStar Georgetown University Hospital is one of the few facilities on the East Coast to offer both lymph node transfer and lymphovenous bypass, singly or in combination.
What is lymph node transfer?
During lymph node transfer surgery, healthy lymph nodes and their accompanying veins or arteries are moved from an unaffected part of the body (often, the back or groin) into the part of the body that is affected by lymphedema. The transferred lymph nodes allow the body to properly drain fluid again.
Lymph node transfer surgery typically takes four to six hours. Patients are discharged within one to three days, with a recuperation period of 3 to 4 weeks.
While some patients notice a degree of relief from pain, heaviness and swelling right away, it typically takes six to nine months for the full benefits of the transfer to become apparent.
What is lymphovenous bypass surgery?
During this procedure, the clinician injects a harmless fluorescent dye into the lymphatic system in order to better observe the functioning of the lymph nodes and surrounding veins. Then, using a high-powered microscope to guide the procedure, the clinician re-routes the lymphatic channels to the veins in order to bypass areas that are damaged or blocked. By doing so, proper flow is restored and lymphatic fluid can begin to drain normally again.
Lymphovenous bypass surgery usually takes one to two hours. Most patients can return home the same day or the next day. The effects of the procedure are often noticeable almost immediately.
Who is eligible for surgical lymphedema treatments?
Most patients with mild to moderate lymphedema can benefit from lymph node transfer and/or lymphovenous bypass, although both procedures tend to be more successful during the earlier stages of the condition.
The procedures are typically not as effective for patients with moderate to severe lymphedema, but the addition of other procedures such as liposuction can improve outcomes.
In rare circumstances, a patient’s lack of viable lymphatic channels makes bypass surgery impossible. For these patients, lymph node transfer alone or in conjunction with liposuction can help reduce symptoms.
What are the risks and benefits of these procedures?
Lymph node transfer and lymphovenous bypass are both generally well-tolerated. Following the surgery, most patients will still need to wear compression garments and perform other self-care on a regular but reduced basis.
Possible side effects include bruising, post-surgical discomfort, and temporary numbness at the surgical site. As with any surgery, there is a small risk of infection.
After lymph node transfer, there is also a very small risk of new lymphedema occurring in the part of the body from the donor lymph nodes were taken. Your surgeon will carefully select the donor lymph nodes in order to minimize this risk.
Many patients find that microsurgical procedures bring significant relief from lymphedema symptoms, including reduced pain and swelling.