Lymphedema is a buildup of lymph fluid or fatty tissues under the skin. It can cause swelling, pain, and discomfort, usually in the arms or legs.
Lymphedema is a common side effect of cancer treatment, especially surgery to treat breast cancer and gynecologic cancers such as ovarian cancer, cervical cancer, and uterine cancer. It also can result from the treatment of melanoma, sarcoma, and tumors arising in the pelvis.
Lymph nodes are removed as part of cancer treatment because they are often where these cancers spread first. While this precaution is essential for controlling or curing your cancer, it can damage the lymphatic system — a network of vessels that filter and clear fluid from the tissues. This sometimes results in lymphedema.
Lymph node removal does not cause lymphedema in everyone. Only 30 to 40% of patients undergoing this procedure develop the condition. Also, it usually takes time for lymphedema to develop (typically eight to 12 months).
Surgical Treatment of Lymphedema
Cancer-related lymphedema may be prevented or treated through specialized surgical techniques. This approach, called microsurgery, involves working with delicate instruments under a microscope to redirect or reconnect small lymphatic and blood vessels.
If lymph nodes are being removed as part of the surgery to treat your cancer, these procedures can be done at the same time to reduce your risk of lymphedema.
They can also be performed in patients who already have lymphedema to reduce symptoms.
Types of Surgery for Lymphedema
If you are a candidate for lymphedema surgery, there are several surgical options.
If you have this procedure, our surgeons redirect lymphatic vessels of the arm or leg into nearby veins, bypassing the lymph nodes that were removed. This allows fluid to continue to drain from the limb. Lymphovenous bypass is typically an outpatient procedure that allows people to return to regular activity within a few days.
Lymph Node Transplantation
In this approach, surgeons transplant lymph nodes from elsewhere in the body to replace those that were removed as part of cancer treatment. MSK microsurgeons have vast experience in treating cancer-related lymphedema with lymph node transplantation, a very delicate operation. This is an inpatient procedure with a recovery time of a few days.
MSK doctors have pioneered methods for carefully selecting which nodes to transplant to avoid having lymphedema develop in the area where these nodes are removed. Our surgeons usually take lymph nodes from inside the abdomen and attach them to one or two sites in the limb affected by lymphedema to help drain the excess fluid.
For some advanced cases of lymphedema, lymphovenous bypass and lymph node transplantation are not possible. In these circumstances, we may use liposuction to remove the fatty tissue that is deposited by lymphedema. We also use liposuction in some patients in addition to lymphovenous bypass and lymph node transplantation.
Why should I choose MSK for lymphedema surgery?
Memorial Sloan Kettering is an international leader in the surgical treatment of cancer-related lymphedema. We have developed groundbreaking treatment options to build individualized care plans for our patients.
MSK reconstructive surgeons are highly skilled at preventing and treating lymphedema through specialized techniques. In particular, Joseph Dayan, Babak Mehrara, and Michelle Coriddi have vast experience in lymph node transplantation.
Our doctors closely collaborate on every case and perform most surgical procedures as a team. This means patients benefit from the skill and experience of two highly trained microsurgeons during the operation. There are very few centers in the world that offer the range and depth of lymphedema surgery procedures, including operations to prevent the disease.
Most lymphatic vessels are very small, less than a millimeter in diameter. At MSK, we use the most advanced imaging technology available to diagnose and evaluate lymphedema. This helps us identify who is at risk for the disease, who may already be developing it, and — if treatment is needed — which approach to use.
- Indocyanine green (ICG)-enhanced near-infrared fluorescence (NIRF) enables our surgeons to get a clear picture of how well lymphatic vessels are transporting fluid. This method provides a real-time image of the lymphatic vessels in the affected limb.
- MRI lymphangiography allows us to see the lymphatic system and determine the amount of fluid and fat in the limb. This helps us see how advanced the condition is and plan your surgery.
- Lymphoscintigraphy uses small amounts of radioactive tracing materials to help visualize your body’s lymphatic system and look for lymphedema at its earliest stages.
We work closely to support you both before and after treatment for lymphedema. Our surgeons are backed by a team of experts who are highly skilled in treating lymphedema and giving all patients a care plan tailored just for them. This includes highly specialized physician assistants, lymphedema therapists, and nurses committed to providing lymphedema care. We follow our patients closely after surgical treatment ends to help them maintain a high quality of life. This is important since close monitoring and early interventions are proven measures that decrease the severity of lymphedema.
MSK is conducting research to better understand how lymphedema develops and progresses.
Our goal is to develop a cure for lymphedema. A clear understanding of the disease process is an important step towards achieving that goal. We are optimistic that this can be achieved in the next ten years.
Our findings have led to clinical trials translating our medical treatments from the laboratory to the bedside.
For years, our dedicated laboratory, which is funded by grants from the National Institutes of Health, the Department of Defense, and other national sources, has investigated the factors that can contribute to development of the disease. There are no other cancer centers with an active lymphedema surgical program supported by a dedicated lymphedema laboratory.
Our research efforts include:
- Identifying which patients are at risk for lymphedema so we can determine who to treat at the time of cancer surgery.
- Gaining a better understanding of the disease process. This includes investigating how the lymphatic system is damaged during cancer treatment. This knowledge helps us develop novel medical treatments that can prevent lymphedema and treat it once develops.