This guide will help you get ready for your lymphovenous bypass (LVB) surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.
Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.
About Your Surgery
Lymphedema is swelling caused by a buildup of lymph fluid. Your limb (arm or leg) with lymphedema is called your affected limb.
Sometimes, lymphedema happens when lymph nodes are removed during surgery or lymphatic vessels (thin tubes that carry lymph fluid) become blocked by scar tissue after surgery. LVB surgery can be done to help treat lymphedema caused by blocked lymphatic vessels.
About LVB surgery
LVB surgery is sometimes called lymphovenous anastomosis (LVA) surgery.
During your LVB surgery, your surgeon will use a microscope and small surgical tools to connect the part of your lymphatic vessel that’s not blocked to a nearby vein (see Figure 1). This lets your lymphatic fluid get past the blockage and flow away from your affected limb.
It’s very hard to know how much change you may have after your surgery. You may be able to see less swelling, your affected limb may feel different, or you may notice other small changes (such as your jewelry fitting differently). Different people will have different results. Your surgeon will talk with you about what to expect after surgery. Some people notice changes right away. Other people don’t notice any change for up to a year after their surgery.
Getting Ready for Your Surgery
This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.
As you read through this section, write down questions to ask your healthcare provider.
Getting ready for surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.
I take a anticoagulant (blood thinner), such as:
These are examples of medications. There are others.
Be sure your healthcare provider knows all the medications you’re taking.
- Warfarin (Jantoven®, Coumadin®)
- Clopidogrel (Plavix®)
- Enoxaparin (Lovenox®)
- Dabigatran (Pradaxa®)
- Apixaban (Eliquis®)
- Rivaroxaban (Xarelto®)
I take an SGLT2 inhibitor, such as:
- Canagliflozin (Invokana®)
- Dapagliflozin (Farxiga®)
- Empagliflozin (Jardiance®)
- Ertugliflozin (Steglatro®)
- I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
- I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
- I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia (medication to make me sleep during surgery) in the past.
- I’m allergic to certain medication(s) or materials, including latex.
- I’m not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
- I use recreational drugs, such as marijuana.
About drinking alcohol
It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medications to help prevent them.
Here are things you can do before your surgery to keep from having problems.
- Be honest with your healthcare providers about how much alcohol you drink.
Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- Feel nauseous (like you’re going to throw up).
- Feel more anxious (nervous or worried) than usual.
- Cannot sleep.
- Tell your healthcare provider if you cannot stop drinking.
- Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.
If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.
About sleep apnea
Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.
OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.
Within 30 days of your surgery
See a lymphedema therapist
A lymphedema therapist is a physical or occupational therapist who specializes in treating lymphedema. Before your LVB surgery, you need to have regular appointments with a certified lymphedema therapist. The lymphedema therapist will work with you to decrease the swelling in your affected limb before your surgery.
Presurgical Testing (PST)
You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location.
You can eat and take your usual medications the day of your PST appointment.
It’s helpful to bring these things to your appointment:
- A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The names and telephone numbers of your healthcare providers.
You’ll meet with a nurse practitioner (NP) during your PST appointment. They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care, such as:
- An electrocardiogram (EKG) to check your heart rhythm.
- A chest X-ray.
- Blood tests.
Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.
Identify your caregiver
Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.
If you don’t have someone to take you home after your surgery, call one of the agencies below. They’ll send someone to go home with you. There’s usually a charge for this service, and you’ll need to provide transportation. It’s okay to use a taxi or car service, but you must still have a responsible care partner with you.
|Agencies in New York||Agencies in New Jersey|
|VNS Health: 888-735-8913||Caring People: 877-227-4649|
|Caring People: 877-227-4649|
Fill out a Health Care Proxy form
If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.
A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
- To learn about health care proxies and other advance directives, read Advance Care Planning.
- To learn about being a health care agent, read How to Be a Health Care Agent.
Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.
7 days before your surgery
Follow your healthcare provider’s instructions for taking aspirin
Aspirin can cause bleeding. If you take aspirin or a medication that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
To learn more, read Herbal Remedies and Cancer Treatment.
2 days before your surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
1 day before your surgery
Note the time of your surgery
A staff member will call you after the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by , call 212-639-5014.
The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.
This will be the following location:
Josie Robertson Surgery Center (JRSC)
1133 York Avenue (between East 61st and East 62nd Streets)
New York, NY 10065
Go to bed early and get a full night’s sleep.
Instructions for eating before your surgery
Do not eat anything after midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.
The morning of your surgery
Instructions for drinking before your surgery
You can drink a total of 12 ounces of water between midnight (12 a.m.) and 2 hours before your scheduled arrival time. Do not drink anything else.
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
- If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.
What to bring
- Your breathing device for sleep apnea (such as your CPAP device), if you have one.
- Your Health Care Proxy form and other advance directives, if you have completed them.
- Your cell phone and charger.
- Only the money you may want for small purchases (such as a newspaper).
- A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
- This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.
Where to park
You should park at the JRSC.
- If you’re arriving on Northbound FDR Drive, you’ll need to go around the block to pull into the driveway on southbound York Ave, between East 62nd and East 61st Streets.
- If you’re arriving on Southbound FDR Drive, take southbound York Avenue and pull into the driveway.
There are several options for parking at the JRSC. There’s a valet service at the JRSC entrance. If you choose to use this service, the valet will park your car next door in the City Parking garage. The valet service is free, but you’ll need to pay the parking garage fee when you leave the JRSC. For more information about parking, call 646-888-7100.
If you choose not to use our valet service, there are nearby garages. You’ll have to pay to park in these garages.
Once you’re in the hospital
Once you enter the JRSC, a concierge will greet you and direct you to the check-in area on the 3rd floor. When you get to the 3rd floor, a staff member will give you a badge to wear. This badge will help your healthcare team know where you are so they can give updates on your progress. A staff member will also ask you for the name and contact information of the person who will take you home after your surgery.
If you have any dietary restrictions (such as kosher, halal, gluten free, or vegetarian), tell us when you check in. We will make sure we give you the food and drink you need.
After you check in, a member of your healthcare team will bring you to the pre-surgical center on the 6th floor.
Get dressed for surgery
When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams.
Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room.
Meet with an anesthesiologist
You’ll also meet with an anesthesiologist before surgery. They will:
- Review your medical history with you.
- Ask you if you’ve had any problems with anesthesia in the past, such as nausea or pain.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you’ll get.
- Answer your questions about your anesthesia.
Get ready for your surgery
You’ll either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots may be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs. If your surgery is on one of your legs, that leg won’t have a boot on it.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.
During your surgery
After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe.
First, your surgeon will inject (give you a shot of) green dye between the fingers or toes on your affected limb. The dye will travel through your lymphatic vessels so it’s easier for your surgeon to see them.
After your surgeon injects the dye, they’ll make about 1 to 5 small incisions (surgical cuts) on your affected limb. Each incision will be about 2 centimeters (¾ inch) long. They’ll use each incision to connect a lymphatic vessel to a nearby vein.
Once your surgery is finished, your surgeon will close your incisions with Steri-Strips™ (surgical tape) or 2 to 3 sutures (stitches).
Your breathing tube is usually taken out while you’re still in the operating room.
Recovering after your surgery
This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.
As you read through this section, write down questions to ask your healthcare provider.
In your recovery room
When you wake up after your surgery, you’ll be in a recovery room. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You may also have compression boots on one or both of your lower legs.
You might have tiny green marks on your affected limb. These are from the dye used during your surgery. They’ll go away in about 1 week.
Managing your pain
Most people have very little pain after LVB surgery. If you have pain, tell your healthcare provider. They may give you pain medication to help manage it.
What to expect
The length of time you’re in the hospital after your surgery depends on your recovery. Most people are discharged from the hospital the same day as their surgery.
While you’re in your recovery room, your healthcare provider will help you get ready to go home. When you’re awake, your healthcare provider will:
- Encourage you to walk. If you had surgery on one of your legs, you can walk on your affected leg right away after your surgery.
- Give you something to eat and drink.
- Review your discharge instructions with you.
- Answer any questions you have.
Before you leave the hospital, look at your incisions with one of your healthcare providers. Knowing what your incisions look like will help you notice any changes later.
Caring for your incisions
Don’t shower or get your incisions wet for 48 hours (2 days) after your procedure.
After 48 hours, you can shower as usual. Let the water run over your incisions when you shower. It’s okay to get your stitches or Steri-Strips wet.
If you go home with stitches in your incisions, your doctor will take them out about 2 weeks after your surgery. If you go home with Steri-Strips on your incisions, they’ll loosen and fall off by themselves. If they haven’t fallen off within 10 days, you can take them off.
Caring for your affected limb
It’s important to take good care of your affected limb to help it heal. The instructions below are general. If your surgeon gives you different instructions, follow those. If you have any questions, call your surgeon’s office.
Avoid putting pressure on or near your incisions until your surgeon tells you it’s okay. For example, avoid sleeping on your affected side and don’t wear tight clothing.
For the first 2 weeks after your surgery:
- Don’t visit your lymphedema therapist.
- Don’t wrap or massage your affected limb.
- Don’t lift, push, or pull anything heavier than 5 pounds (2.3 kilograms). A gallon of milk is about 8 pounds (3.3 kilograms). You’ll need help with things like doing laundry and carrying groceries.
- Keep your affected limb elevated as often as you can. It’s best to rest your limb on 2 pillows while you’re sitting or sleeping, if you can. This will help prevent swelling while you’re not wrapping your affected limb.
- Depending on where your incisions are, your surgeon may tell you to avoid raising your arm above your shoulder. Follow their instructions.
Starting 2 weeks after your Surgery:
- You can visit your lymphedema therapist.
- You can wrap your affected limb. It’s okay to wrap over your incisions.
- You can massage your affected limb, but don’t massage over your incisions.
- You can start using your compression garment again.
- Keep following the same lifting, pushing, and pulling restrictions. Don’t lift, push, or pull anything heavier than 5 pounds (2.3 kilograms).
Starting 4 Weeks After Your Surgery:
- You can wrap and massage over your incisions.
- You don’t need to follow any restrictions. You can go back to all your usual activities.
Going back to work
Talk with your healthcare provider about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk.
MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.
Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.
When to Contact Your Healthcare Provider
Contact your healthcare provider if:
- You have a fever of 100.5 °F (38 °C) or higher.
- The skin around your incision is warmer than normal.
- The skin around your incision is getting more red.
- The area around your incision is starting to swell.
- Swelling around your incision is getting worse.
- There’s new drainage (liquid) coming from your incision.
- You have any questions or concerns.
Monday through Friday from to , contact your doctor’s office.
After , during the weekend, and on holidays, call 212-639-2000 and ask to speak to the doctor on call for your doctor.
This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.
As you read through this section, write down questions to ask your healthcare provider.
MSK support services
Visit the cancer types section of MSK’s website at www.msk.org/types for more information.
Call if you have questions about your hospital admission, such as asking for a private room.
At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.
Food Pantry Program
We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.
Integrative Medicine Service
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010.
You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.
Patient and Caregiver Education
Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
Call if you have questions about the Health Care Proxy form or concerns about your care.
Perioperative Nurse Liaison
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nurses and Companions
You can request private nurses or companions to care for you in the hospital and at home. Call for more information.
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.
- Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. To learn more, call Rehabilitation Medicine (Physiatry) at 646-888-1929.
- An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. To learn more, call Rehabilitation Therapy at 646-888-1900.
Resources for Life After Cancer (RLAC) Program
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.
This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.
Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.
- Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. For more information or to make an appointment, call 646-888-5076.
- Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.
Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills.
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).
MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.
Tobacco Treatment Program
MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.
Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.
Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.
External support services
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.
American Cancer Society (ACS)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
Cancer and Careers
A resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
Provides support and education to people affected by cancer.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.
LGBT Cancer Project
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
Look Good Feel Better Program
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.
National Cancer Legal Services Network
Free cancer legal advocacy program.
National LGBT Cancer Network
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Advocate Foundation
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.
As you read through these resources, write down questions to ask your healthcare provider.
- Advance Care Planning
- Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
- Herbal Remedies and Cancer Treatment
- How to Be a Health Care Agent
For more information about lymphedema, you can also read the New York State Department of Health’s resource Understanding Lymphedema.