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Liang et al. Plast Aesthet Res 2023;10:71 Plastic and
DOI: 10.20517/2347-9264.2023.81
Aesthetic Research

Original Article Open Access

Preoperative ultrasound evaluation for
lymphaticovenous anastomosis surgery in advanced

breast cancer-related lymphedema

3,4
1
Wei-hao Liang , Isao Koshima 2 , Chao-Ming Hung , Richard Chih-Hau Chang 4
1
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore 169608, Singapore.
2
Department of Plastic and Reconstructive Surgery, International Center for Lymphedema, Hiroshima University Hospital,
Hiroshima 734-8551, Japan.
3
Department of Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan.
4
Department of Plastic and Reconstructive Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan.
Correspondence to: Dr. Richard Chih-Hau Chang, Department of Plastic and Reconstructive Surgery, E-Da Cancer Hospital, I-
Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 824005, Taiwan. E-mail: igor8301023@gmail.com
How to cite this article: Liang Wh, Koshima I, Hung CM, Chang RCH. Preoperative ultrasound evaluation for lymphaticovenous
anastomosis surgery in advanced breast cancer-related lymphedema. Plast Aesthet Res 2023;10:71. https://dx.doi.org/10.20517/
2347-9264.2023.81
Received: 27 Aug 2023 First Decision: 6 Nov 2023 Revised: 30 Nov 2023 Accepted: 27 Dec 2023 Published: 29 Dec 2023

Academic Editor: Hiroo Suami Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Aim: Lymphaticovenous anastomosis (LVA) is the mainstay for treating breast cancer-related lymphedema
(BCRL). Preoperative ultrasonography is useful to assess the locations and characteristics of lymphatics and veins
to improve LVA success remarkably even in cases of advanced BCRL. Aim: The aim of the study was to describe
the use of ultrasonography to reliably map suitable lymphatics and veins and successfully perform LVA surgery in
cases of advanced BCRL.

Method: This retrospective cohort study included 41 cases of BCRL who underwent LVA surgery using
preoperative ultrasound to map and characterize lymphatics and veins. Cases were analyzed for the following: (1)
whether preoperative ultrasonographic detection of both lymphatics and veins correlate to actual intraoperative
findings and (2) improvement in mean limb circumference measurements at 1 and 3 months of follow-up in this
patient cohort.

Results: For 155 LVA incisions, 212 LVA procedures were performed. Among them, 133 (62.7%) lymphatics and
196 (92.4%) anti-reflux veins were successfully detected and characterized on preoperative sonography. Mean

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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