Optimizing Treatment of Breast Cancer Related Lymphedema Using Combined DIEP Flap and Lymphedema Surgery

Abstract

Patients undergoing treatment for breast cancer who undergo an axillary dissection and require adjuvant therapies such as radiation and chemotherapy are at high risk of developing lymphedema of the associated extremity. Historically, patients with lymphedema were treated with ablative procedures aimed simply to remove excess fluid and adiposity; however, the field of lymphatic surgery employing super-microsurgery techniques has witnessed tremendous advances in a relatively short period of time. Advancements in surgical instruments, microscope magnification and optics, imaging technology, and surgeon experience have ushered in a new era of hope to treat patients suffering from breast cancer–related lymphedema (BCRL). Here we aim to present the available options for patients suffering from BCRL, and the pinnacle in reconstruction and restoration for these patients.

Lymphatic System – Surgeon’s Point of View

“…The vascularized groin lymph node flap was the first to be described and remains the most commonly used donor site for VLNT [46]. This flap is based on the superficial circumflex iliac vessels and is favored due to well-described anatomic studies, a wellconcealed scar, and feasibility to be combined with breast reconstruction [47,48]. The major complication associated with its harvest is the possibility of causing iatrogenic secondary lymphedema.…”

Current trends in postmastectomy breast reconstruction

“…This flap has clearly defined anatomical landmarks [41] and thanks to reverse mapping [42] minimal donor site morbidity can be achieved. Furthermore, it can be used as a combined chimeric flap with a DIEP-flap to reconstruct the breast as well as improve the lymphatic drainage from the affected arm [43].…”