Lymphedema prevention surgery for people with breast cancer

An innovative surgery can help lower the risk that patients with breast cancer and some other cancers develop lymphedema. The procedure is called immediate lymphatic reconstruction but is more commonly known as lymphedema prevention surgery.

Lymphedema occurs when the lymphatic vessels and lymph nodes, which are part of the system that drains fluid and helps fight infection in the body, are damaged or removed and can no longer function normally. A chronic and often uncomfortable condition, lymphedema can occur after treatment such as a mastectomy, underarm lymph node surgery or radiation.

For breast cancer patients, swelling usually affects the arm, hand or chest on the side of the body where they had surgery. Many patients wear compression sleeves to control swelling. And according to the National Institutes of Health, 1 in 5 women treated for breast cancer have lymphedema, although the risk depends on the type of treatment needed.

"It can be very uncomfortable, and people with lymphedema are also more prone to infection from small cuts and scratches," says Dr. Cagri Cakmakoglu, a plastic surgeon with Sharp Community Medical Group and affiliated with Sharp Memorial Hospital and Sharp Chula Vista Medical Center. "Now we have a procedure that can change all of that," he says.

Lowering the risk of lymphedema before it develops

"Sharp is one of the few health care organizations providing lymphedema prevention surgery in Southern California," Dr. Cakmakoglu says.

The procedure is designed to significantly reduce the chance of developing lymphedema. It is considered a type of reconstruction surgery.

“I connect the tiny lymphatic vessels that were cut during lymph node removal to a nearby small vein," Dr. Cakmakoglu explains. “This lets the lymph fluid drain into the bloodstream instead of building up and causing swelling.”

Lymphedema prevention surgery can be done during a breast cancer procedure, such as a mastectomy or during removal of the underarm lymph nodes. The key is prevention, rather than treatment.

“Traditionally, lymphedema was addressed once it was diagnosed,” says Dr. Cakmakoglu. “This surgery aims to reduce the risk of lymphedema before it develops. It’s a proactive approach instead of a reactive one.”

Who is a good candidate for lymphedema prevention surgery?

Lymphedema prevention surgery is generally offered to patients who need all underarm lymph nodes removed. It is not typically recommended for patients who need only one or a few lymph nodes removed because their lymphedema risk is much lower.

People who have not yet developed lymphedema and have advanced breast cancer may also be eligible for lymphedema prevention surgery. "The more extensive the breast cancer surgery or underarm surgery is, the more lymphatic vessels are affected and the greater the risk of lymphedema," says Dr. Cakmakoglu.

He adds that patients who undergo radiation treatment to the lymph node area under the arm have a substantially higher risk of developing lymphedema than those treated with surgery alone. The risk is about 30% with surgery and rises to roughly 50% when radiation is added.

Benefits for patients

For eligible patients, this surgery can lower the likelihood of needing long-term lymphedema care such as wearing compression sleeves, physical therapy and lymphatic massage.

"After surgery, the patient's arm is wrapped to provide compression for about two weeks while they recover," says Dr. Cakmakoglu. “Once that is removed and everything looks good, most patients can return to their normal lives.”

Ongoing monitoring for lymphedema remains important. A small number of patients may still develop lymphedema. Doctors will continue to watch for early signs of the condition after surgery, as lymphedema is easiest to manage when caught early.

Public awareness

Education has been the biggest obstacle to offering this treatment to more patients, Dr. Cakmakoglu adds. But public awareness is gradually growing.

"Many of my patients didn't even know this surgery was an option,” he says. “Once they find out about it, they're very glad to know it's available. I'm also working to educate more surgeons about it so they can inform their patients.”

Insurance coverage varies by plan, so patients should check with their insurer, says Dr. Cakmakoglu. He encourages patients to talk with their care team to determine whether this surgery may be right for them.

Learn more about breast cancer treatment at Sharp and Sharp's comprehensive Lymphedema Prevention and Treatment Program.