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Laustsen-Kiel et al. Plast Aesthet Res 2024;11:17 https://dx.doi.org/10.20517/2347-9264.2024.32 Page 9 of 18

Figure 2. Treatment of subclinical lymphedema with compression garments.

water-based exercise on pain or discomfort [146,160] . In conclusion, no clear advantage was seen for any
treatment methods, regardless of whether the comparison was made with active or non-active control
conditions.

Surgical treatment modalities and emerging therapies and research
Complete decongestive therapy has for many years been the primary treatment ; however, microsurgical
[161]
techniques were implemented in the treatment of lymphedema in the seventies, where lymphatic venous
anastomosis (LVA) was first used to treat postoperative lymphedema . Since then, multiple studies on
[162]
LVA have been undertaken [163-165] . A smaller study involving ten patients undergoing LVA from 2008
[166]
showed minimal reduction in lymphedema volume and only minimal improvement in QoL . However, a
case series of 20 patients by Chang et al. showed a reduction in lymphedema volume of 35% and a 95%
improvement in lymphedema symptoms after one year . A larger study involving 169 BCRL patients
[167]
undergoing autologous lymph vessel transplantation from the ventromedial lymphatic bundle at the
patient’s thigh to the upper limb found that microsurgical technique significantly and persistently improved
lymph drainage in patients with lymphedema . Recently, a systematic review found 102 studies
[168]
[169]
investigating LVA, concluding that LVA can reduce the severity of secondary lymphedema ; however,
standardization of reporting is needed to allow further comparability between methods and studies. LVA
has recently emerged as a preventive therapy, where axillary reverse lymphatic mapping and immediate
[170]
lymphaticovenous bypass are increasingly used in the operating room worldwide . Several studies report a
lower prevalence of BCRL in cohorts where lymphaticovenous bypasses were performed as a preventive
approach [171-177] . Nevertheless, not all studies confirmed the long-term effects of the Lymphatic Microsurgical
Preventive Healing Approach (LYMPHA) on BCRL .
[178]