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Jabbour et al. Plast Aesthet Res 2021;8:43 https://dx.doi.org/10.20517/2347-9264.2021.59 Page 9 of 12

gene therapy to enhance tissue regeneration [62,63] . Combining stem cell therapy with increased expression of
VEGF-C in a VLNT with gene therapy to augment and enhance the process of lymphangiogenesis hopes to
achieve more dramatic and improved outcomes. Preliminary outcomes have demonstrated promising
results, and future studies are developing, which may ultimately revolutionize the treatment and perhaps
even cure lymphedema [64-66] . Other alternative strategies are also emerging on a regular basis using collagen
scaffolds to direct lymphangiogenesis which is based on prior studies using muscle as a biologic bridge [67,68] .
Perhaps there are potential medical strategies that will revolutionize the treatment of lymphedema, making
the need for surgery obsolete [69,70] .

Ultimately, the future of lymphedema surgery lies in prevention. As the need for full regional nodal
dissections decreases and preventative strategies become more and more popular, hopefully, the incidence
of lymphedema can be reduced significantly. Preliminary early outcomes in the prophylactic repair of the
lymphatic vessels during an axillary dissection are promising. However, a number of different techniques
are currently employed, and longer follow-up is needed to ascertain the true efficacy of the PREVAIL and
LYMPHA technique [71,72] . However, despite the reduction in the risk of developing lymphedema, as
treatment modalities continue to improve survival, there will undoubtedly still be a need for the treatment
of lymphedema. Regardless, the goals and objectives aim to improve the quality of life of patients suffering
from this debilitating condition; however, there remains a need for a comprehensive, validated patient-
reported outcomes (PROs) metric [73,74] . Many of the current PROs measures are quite functional and provide
important objective measures for patients documenting the benefits of lymphedema surgery for this
complex cohort of patients. While plastic surgeons, particularly those with experience with microsurgery,
are well-acquainted with the benefits of lymphedema surgery, we must continue to advance the field and
optimize the treatment for those suffering from lymphedema.

CONCLUSIONS
The field of lymphedema surgery continues to grow, expand, and evolve, which is critical to optimizing
patient outcomes and improve patients’ quality of life. The field has already grown tremendously since its
inception, but the foundation has been prepared for further advancements in the near future.

DECLARATIONS
Authors’ contributions
Were both responsible for composing the manuscript, performing the literature review and critical editing
of the manuscript: Chang EI, Jabbour S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

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

Ethical approval and consent to participate
Not applicable.