Current Concepts in Management of Postmastectomy Lymphedema

Abstract

Lymphedema is associated with irreversible changes in the lymphatic system. For this reason, it is difficult to develop a radical treatment due to the dermal sclerosis and the volume increase of fibrous and adipose tissues. Complex decongestive therapy (CDT) is the gold standard in every therapeutic protocol. However, in cases that conventional therapy is inadequate or unsuccessful, new surgical treatments are available nowadays combining microvascular reconstructive techniques: Lympho-Venous Anastomosis (LVA), Vascularized Lymph Node Transfer (VLNT), Lympho-Lymphatic Bypass (LL-Bypass). Finally, for simultaneous breast reconstruction and restoration of lymphedema, chimeric Diep Inferior Epigastric Perforator flap (DIEP flap) can be combined with vascularised lymph node transfer (VLNT) from the inguinal area. Retrospective review of the literature referred to the diagnosis and the treatment of primary or secondary lymphedema. Conventional, as well as microvascular techniques are shown with detailed description of each procedure. Worldwide interest in using microsurgical reconstructive techniques to treat lymphedema is gaining momentum. However, there is no consensus on the indications for which procedure to perform, when to intervene, and/or how to comparatively grade outcomes. Currently there is no cure for lymphedema. For this reason, further research and better understanding of lymphatic anatomy and lymphedema pathophysiology are needed in order to improve further the conventional as well as the surgical methods.