Page 151 - Read Online

Nardulli. Plast Aesthet Res 2020;7:15 Plastic and
DOI: 10.20517/2347-9264.2019.56 Aesthetic Research

Review Open Access

Breast cancer-related lymphedema: focus on
surgical treatment

Maria Luisa Nardulli

Department of Plastic Surgery and Burns, Breast Reconstruction Unit, Perrino Hospital, Brindisi 72100, Italy.

Correspondence to: Dr. Maria Luisa Nardulli, Department of Plastic Surgery and Burns, Breast Reconstruction Unit, Perrino Hospital,
Brindisi 72100, Italy. E-mail: marialuisanardulli@gmail.com
How to cite this article: Nardulli ML. Breast cancer-related lymphedema: focus on surgical treatment. Plast Aesthet Res 2020;7:15.
http://dx.doi.org/10.20517/2347-9264.2019.56

Received: 20 Nov 2019 First Decision: 11 Feb 2020 Revised: 5 Mar 2020 Accepted: 10 Mar 2020 Published: 31 Mar 2020

Science Editor: Xiao Long Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract

Breast cancer-related lymphedema (BCRL) can affect breast cancer patients, especially after axillary surgery and
radiation treatment, for life. First line treatment is conservative and involves physical therapy and compression. It
requires absolute, life-long compliance with treatment by the patient and, in some cases, it is ineffective. In recent
years, surgery has emerged as a possible alternative or even, complementary therapy for BCRL. The most commonly
reported techniques are reconstructive or debulking procedures. Reconstructive procedures are aimed at restoring the
lymphatic pathways and can be effective early in the disease process, when increased arm volumes are mostly due to
the accumulation of protein-rich fluid in the interstitial space. In more advanced stages, where fibrotic and hypertrophic
adipose tissues are dominant, debulking techniques such as liposuction can be recommended. A standard of care for
the treatment of BCRL has not been established. Currently, different techniques can be combined to optimize clinical
outcomes, and the surgical approach must be individualized for each patient, based on sound clinical and imaging
assessment. BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.

Keywords: Breast cancer-related lymphedema, vascularized lymph node transfer, lymphaticovenous anastomosis, liposuction,
fat grafting

INTRODUCTION
Breast cancer-related lymphedema (BCRL) is a well-known, potential sequela of breast cancer treatment,
which can result in damage to and impairment of the lymphatic drainage system of the upper limb.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.parjournal.net