Lymphedema: Causes and Advances in Treatment

Lymphedema is an abnormal accumulation of lymphatic fluid that occurs in women who have undergone surgery to defeat breast cancer. It is a chronic, progressive swelling disorder in the arms that should be prevented and diagnosed as soon as possible so that it can be treated.

Causes and origin of lymphedema

The incidence of the appearance of lymphedema in the upper extremities after surgical treatment of breast cancer is highly variable, with published data ranging from 6 to 60%, depending on the population studied, the measurement criteria and the follow-up period. Its main origin is the interruption of lymphatic vessels during breast cancer surgery, but secondary lymphedema can also appear as a consequence of the treatment of other tumors such as melanoma or sarcomas.

A common feature of these types of tumors is the spread of the disease via the lymphatic route, with the consequent need to remove regional lymph nodes.

Lymphedema affects quality of life

In addition to the increase in volume in the affected limb, lymphedema has physical consequences such as heaviness, discomfort and pain; and functional consequences such as limited movement, need for pressure therapy garments and increased frequency of infectious episodes in the limb.

Since the development of lymphedema depends on many factors, in practice it is very difficult to prevent. For this reason, in addition to applying all possible measures to reduce morbidity or surgical aggressiveness, such as the sentinel lymph node technique, close postoperative follow-up is of vital importance in order to establish an early diagnosis in the event that early medical and/or surgical treatment is necessary. In fact, a relevant problem in long evolution, established or chronified lymphedema is the fact that the tissues with greater volume during a long time develop fibrosis and hardening, leaving this volume as fixed and not reversible, not even by applying surgical treatment.

Treatment of lymphedema

The treatment of lymphedema has two aspects: rehabilitation treatment and surgery.

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Rehabilitative treatment consists of the use of pressure therapy garments to contain fluid accumulation, as well as lymphatic drainage massages to try to reduce the fluid before it becomes chronic. This physical and rehabilitative treatment is essential for prevention and early control.

Unfortunately, sometimes prevention is not achieved and the problem becomes more complicated. For these cases, Plastic Surgery has provided several surgical techniques that have been developed in recent years and are still undergoing further research and development.

The surgical options for the treatment of lymphedema currently include two main procedures:

1º The lymphatic-venous anastomosis:
Since the lymphatic pathway has been limited in its course at the level of the axilla or groin, in the case of the legs, the idea is to try to redirect the lymphatic flow before the blockage towards the superficial venous system. This is done by connecting or suturing one or more lymphatic vessels with small neighboring venules. This surgery is usually performed in several operations over 6 to 12 months.
These connections require a supermicrosurgical technique performed under an operating microscope and with extremely fine suture material and instruments.

2º Transfers of complex lymphatic-ganglionic units:
In this option, the idea is to transfer groups of fat tissue carrying lymph nodes and their corresponding lymphatic pathways, taken from healthy areas, and connect them to recipient blood vessels located in the problematic area. The objective is not only to try to improve the fluidity of lymphatic drainage, but also to provide healthy tissue to generate a new defensive barrier in the damaged area.

It is crucial on the part of professionals to help inform, disseminate and raise awareness of this problem and the treatment options available, in order to promote greater prevention and early detection of this chronic problem that currently affects so many women.

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