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Page 12 of 15 Sarrami et al. Plast Aesthet Res 2024;11:13 https://dx.doi.org/10.20517/2347-9264.2024.06

[46]
their lower arm and hand . Surgeons who believe that VLNT works by promoting lymphangiogensis often
position the lymph nodes in the axilla to restore physiologic lymph flow [4,7,8] . Placement of the flap in the
[22]
axilla is also more cosmetically appealing, because distal flaps are bulky and may require a skin graft .
[14]
Successful lymphedema management has been described at all three recipient sites .

A growing body of literature in the field of lymphedema calls for improved preventative lymphatic surgery
options [51-53] . Standard practice at several institutions now supports immediate lymphatic reconstruction at
the time of axillary dissection [51,52,54] . Similarly, preventative VLNT at the time of mastectomy is now being
tested. Immediate breast reconstruction has also been correlated to reduced lymphedema development, but
there are considerable confounding variables in these studies . Currently, there is not enough evidence to
[2,3]
state the true benefit of combining immediate autologous reconstruction with preventative lymphatic
surgery, but we are confident the literature will continue to grow.

This literature review has several limitations. Due to the novelty of the topic, there is a relatively small
number of studies available. Most of the cited outcomes, benefits, and pitfalls are provided from case series
which can have highly variable results. This makes it especially difficult to directly compare chimeric flap
options. Additionally, evaluation of our own results is limited by the retrospective nature of the review and
a small patient population.

CONCLUSION
Advancements in the field of plastic and lymphatic surgery have created multiple autologous breast
reconstruction procedures that can be combined with a lymph node transfer in a single operation. Although
each option has distinct advantages and disadvantages, all of them adequately restore breast and lymphatic
anatomy.

DECLARATIONS
Authors’ contributions
Played a role in the conception of the work, research of included topics, and drafted the manuscript:
Sarrami SM
Outlined key concepts for the work and provided substantial revisions: De La Cruz C

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Consent has been gained for all images and no Institutional Review Board (IRB) approval is required.
Informed consent has been obtained from patients.

Consent for publication
Written informed consent for publication has been obtained for all patient images.