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      Is Open Access

      Evolution in Surgical Management of Breast Cancer-related Lymphedema: The MD Anderson Cancer Center Experience

      , MD, FACS, , MD, MBChB, MSc, MEd, , MD, PhD, FACS, , MD, FACS, , MD, FACS

      Plastic and Reconstructive Surgery Global Open

      Wolters Kluwer Health

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Introduction:

          Lymphedema is a lifelong, debilitating condition that plagues a large portion of patients who have undergone multimodality therapy for breast cancer. With the increasing experience in supermicrosurgical treatment of lymphedema, reconstructive surgeons have made a tremendous impact in improving the quality of life of patients suffering from breast cancer related lymphedema.

          Methods:

          Historical review of our evolution in treatment and management of breast cancer related lymphedema and implementation of our new algorithm. Retrospective review of patients who have undergone both the lymphovenous bypass and vascularized lymph node transfer with autologous breast reconstruction.

          Results:

          The combined Breast Reconstruction Including Lymphovenous bypass and Inguinal to Axillary Node Transfer (BRILIANT) demonstrates promising outcomes. Thirty-eight patients (average age: 52.9 years, average BMI: 32.6 kg/m2) who have undergone the BRILIANT approach have all demonstrated improvements in their lymphedema. With an average follow-up of 19.1 months, no patients suffered a post-operative cellulitis, and 81.6% of patients also demonstrated a volume reduction.

          Conclusion:

          Our new algorithm combining breast reconstruction with lymphedema surgery represents an evolution in our approach to treatment of breast cancer related lymphedema has demonstrated promising results with long-term outcomes.

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          Most cited references 18

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          A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema.

          The authors prospectively evaluated the efficacy of lymphovenous bypass in patients with lymphedema secondary to cancer treatment.
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            Operative treatment of peripheral lymphedema: a systematic meta-analysis of the efficacy and safety of lymphovenous microsurgery and tissue transplantation.

            The purpose of this study was to quantify the efficacy and safety of microsurgery for lymphedema through a systematic meta-analysis, which has not been described before. A literature search was conducted to identify all articles involving microsurgical treatment of lymphedema. Studies meeting criteria for inclusion were rated on methodologic quality based on the American Society of Plastic Surgeons levels of evidence. Demographic information, cause of lymphedema, and surgical technique were recorded. Quantitative change in lymphedema and perioperative complications were noted. Twenty-seven studies were included, with 24 offering level IV evidence and three offering level III evidence. Lymphovenous shunt procedures were performed in 22 studies and lymph node transplantation was performed in five. Excess circumference was reduced by 48.8 ± 6.0 percent, and absolute circumference was reduced by 3.31 ± 0.73 cm. Studies reporting change in volume demonstrated reduction in excess volume by 56.6 ± 9.1 percent, and absolute volume was reduced by 23.6 ± 2.1 percent. The incidence of no improvement in lymphedema postoperatively was 11.8 percent, and 91.2 percent of patients reported subjective improvement. Approximately 64.8 percent of patients discontinued compression garments at follow-up. Complications included operative-site infection (4.7 percent), lymphorrhea (7.7 percent), reexploration for flap congestion (2.7 percent), and additional procedures (22.6 percent). Operative interventions for peripheral lymphedema appear to provide consistent quantitative improvements postoperatively, with a relatively wide safety margin. Lymph node transplantation may provide better outcomes compared with lymphovenous shunt, but well-designed head-to-head comparisons are needed to evaluate this further. Therapeutic, III.
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              Comprehensive review of vascularized lymph node transfers for lymphedema: Outcomes and complications.

              Lymphedema remains a challenging clinical problem. A new field of lymphatic surgery using micro and super microsurgery techniques is a rapidly advancing field aimed to treat recalcitrant cases. The objective of this study was to evaluate outcomes and complications of vascularized lymph node transfer (VLNT). Several early preliminary studies have reported promising outcomes, but they are limited by small numbers, short follow-up, and are inconsistent in addressing the origin and recipient site of the transferred lymph nodes as well as the donor site morbidity.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                March 2020
                27 March 2020
                : 8
                : 3
                Affiliations
                Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
                Author notes
                Edward I. Chang, MD, FACS, Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, 1400 Pressler Drive, 19.500, Houston, TX 77030, E-mail: eichang@ 123456mdanderson.org
                Article
                00024
                10.1097/GOX.0000000000002674
                7253265
                Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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