Lymphaticovenular Anastomosis for Lymphorrhea after Expander-based Breast Reconstruction: A Case Report

Abstract

ymphatic leakage and seroma formation after axillary lymph node dissection in breast cancer surgery is a common complication. Although various methods of prevention and treatment have been reported, there is no effective treatment for refractory axillary lymphorrhea. 1 Lymphaticovenular anastomosis (LVA) is a standard technique for the treatment of secondary lymphedema, and recent reports have demonstrated that LVA was effective for lymphatic cysts and leakage in the inguinal and pelvic regions. [2][3][4] Yet, only a few reports have touched on the efficacy of LVA for axillary lymphorrhea. 3,5 This report presents our experience with LVA for refractory axillary lymphorrhea in postoperative breast cancer. CASE REPORTA 68-year-old woman underwent nipple-sparing mastectomy (her nipple was unfortunately resected due to necrosis several days after surgery) and level Ⅰ and Ⅱ axillary lymph node dissection for right breast cancer, and immediate subpectoral tissue expander (TE) breast reconstruction was performed. However, the volume of axillary drainage remained about 200 mL per day even after 20 days postoperatively. Given that further drainage was unlikely to reduce drainage volume, the drain was removed. Subsequently, a seroma formed around the TE, and the patient began to complain of pain due to chest tenderness. Percutaneous puncture was continued twice a week, with a drainage volume per puncture Breast