Lymphovenous anastomosis (LVA) for treatment of secondary breast lymphedema: A case report and literature review

Abstract

Breast lymphedema (BLE) is a rather common complication occurring after surgical breast cancer treatment. Microsurgical lymphovenous anastomosis (LVA) is a validated technique for the management of lymphedema in the extremities and it is gaining approval also for the breast one. Here, we report a case of breast lymphedema successfully treated with LVA. A 52 years old woman referred chronic erythema, diffuse swelling and pain after breast surgery, axillary lymphnode dissection and adjuvant radiotherapy. Conservative treatments had been performed for 14 months without improvement of symptoms. The patient was then referred for surgery and multiple LVAs were performed at the right breast. A total of 3 LVAs have been performed, two lymphatic vessels were anastomosed to a single Y‐shaped vein and one additional vessel was linked to another nearby vein of similar caliber. All the LVAs were executed using 12–0 microsutures and their patency was confirmed with intraoperative ICG lymphography. Immediately after this intervention the swelling decreased in size and the erythema disappeared and a sensation of relief was reported by the patient. The postoperative course was uneventful and at the 6 and 12 months follow up no signs and symptoms of recurrence were noted. Therefore, we believe that this case adds another significant evidence of the efficacy of LVA for treatment of secondary BLE refractory to conservative treatment. Moreover, we provide a literature review of previous reports of breast lymphedema treated recurring to this procedure.

Combining superficial and deep lymphovenous anastomosis for lymphedema treatment: Preliminary results

“…In our clinical praxis we have a rather large experience of successful results with superficial LVAs, showing effective results, good satisfaction from the patients and no need for further procedures (Scaglioni et al, 2020a;Scaglioni et al, 2020b;Scaglioni et al, 2020c). However, there are also cases in which this goal is not straightforward.…”

Indocyanine Green Lymphography for Evaluation of Breast Lymphedema Secondary to Breast Cancer Treatments

“…10 16 17 31 Clear lymph flow visualization is useful also for navigation of BL treatments. 9 10 19 21 26 28 39 40 Manual lymph drainage can be optimized based on ICG lymphography findings, and lymphovenous shunt operations can be done via a small incision under ICG lymphography navigation. 26 30 39 40…”

Primary lymphedema of breast, a case report

“…Lymph stasis is an adverse outcome of long-period inflammation, which may end with vessel sclerosis that is resistant to treatment. So, regardless to the type of lymphedema (arm, breast), it is crucial to precisely monitor the incidence after surgery [13] . Various modalities are available to diagnose lymphedema such as MRI, volume measurement by water displacement and geometrical calculation, Lymphoscintegraphy, multiple frequency bioelectrical impedance analysis (MFBIA).…”

“…The main treatment modality is conservative measures including massage, compression bandaging, exercise, tight bra and skin care [13] , [15] . Lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT) and debulking surgery are the common surgical interventions.…”