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Sarrami et al. Plast Aesthet Res 2024;11:13 Plastic and
DOI: 10.20517/2347-9264.2024.06
Aesthetic Research

Review Open Access

Two birds one stone: lymphatic and breast
reconstruction with autologous tissue

Shayan M. Sarrami, Carolyn De La Cruz

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Correspondence to: Dr. Carolyn De La Cruz, Department of Plastic Surgery, University of Pittsburgh Medical Center, 5200
Centre Ave Suite 703, Pittsburgh, PA 15213, USA. E-mail: delacruzc@upmc.edu

How to cite this article: Sarrami SM, De La Cruz C. Two birds one stone: lymphatic and breast reconstruction with autologous
tissue. Plast Aesthet Res 2024;11:13. https://dx.doi.org/10.20517/2347-9264.2024.06

Received: 10 Jan 2024 First Decision: 27 Mar 2024 Revised: 3 Apr 2024 Accepted: 9 Apr 2024 Published: 12 Apr 2024

Academic Editor: Tine Engberg Damsgaard Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Patients with breast cancer-related lymphedema (BCRL) commonly present with both debilitating upper extremity
symptoms and the need for breast reconstruction. By combining autologous flaps with physiologic lymphatic
surgery, postmastectomy patients with BCRL can obtain aesthetic breast reconstruction and lymphedema
management in a single operation. Lymph node transfer to an area of lymphatic obstruction creates a healthy
lymphatic bridge and restores physiologic flow. Early success and improved understanding of vascularized lymph
node transfer (VLNT) physiology have led to the rapid development of numerous flap options and modalities.
Several studies have shown the efficacy of combining autologous breast reconstruction with VLNT. Chimeric flaps
using inguinal nodes, lateral thoracic nodes, or omentum aim to construct an aesthetic breast and improve
lymphatic function. In this article, we will detail the surgical options that accomplish autologous breast
reconstruction and restore the lymphatic network in a single operation.

Keywords: Breast reconstruction, lymphedema, breast cancer-related lymphedema, vascularized lymph node
transfer

INTRODUCTION
Patients with breast cancer-related lymphedema (BCRL) commonly present with both debilitating upper
extremity symptoms and the need for breast reconstruction. Approximately 20% of patients receiving

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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