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Friedman et al. Plast Aesthet Res 2023;10:23 Plastic and
DOI: 10.20517/2347-9264.2022.100
Aesthetic Research

Review Open Access

Immediate lymphatic reconstruction for the
prevention of breast cancer-related lymphedema: an

experience highlighting the importance of lymphatic
anatomy

Rosie Friedman, Jacquelyn R. Kinney, Aneesh Bahadur, Dhruv Singhal

Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA 02215, USA.
Correspondence to: Dr. Dhruv Singhal, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center,
Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA 02215, USA. E-mail: dsinghal@bidmc.harvard.edu
How to cite this article: Friedman R, Kinney JR, Bahadur A, Singhal D. Immediate lymphatic reconstruction for the prevention of
breast cancer-related lymphedema: an experience highlighting the importance of lymphatic anatomy. Plast Aesthet Res
2023;10:23. https://dx.doi.org/10.20517/2347-9264.2022.100

Received: 1 Sep 2022 First Decision: 23 Feb 2023 Revised: 21 Apr 2023 Accepted: 18 May 2023 Published: 23 May 2023

Academic Editors: Xiao Long, Edward Chang Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Immediate lymphatic reconstruction (ILR) has become increasingly utilized for the prevention of breast cancer-
related lymphedema (BCRL). A growing body of evidence has demonstrated the long-term efficacy of ILR in
reducing the rate of BCRL. While certain risk factors for BCRL are well-recognized, such as axillary lymph node
dissection, regional lymph node radiation, and elevated body mass index, other potential risk factors such as age
and taxane-based chemotherapeutics remain under discussion. Our experience with ILR has highlighted an
additional potential risk factor for BCRL. Lymphatic anatomy, specifically compensatory lymphatic channels that
bypass the axilla, may play a largely underrecognized role in determining which patients will develop BCRL after
ILR. Foundational anatomic knowledge has primarily been based on cadaveric studies that predate the twentieth
century. Modern approaches to lymphatic anatomical mapping using indocyanine green lymphography have
helped to elucidate baseline lymphatic anatomy and compensatory channels, and certain variations within these
channels may act as anatomic risk factors. Therefore, the purpose of this review was to highlight ways in which
variations in lymphatic anatomy can inform the application and improve the accessibility of this procedure. As ILR
continues to advance and evolve, anatomical mapping of the lymphatic system is valuable to both the patient and
lymphatic microsurgeon and is a critical area of future study.

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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