Understanding Lymphodemia Of Upper Limb Post Breast Cancer Surgery

What is Lymphedema and Its Complications?

While medical advances have increased the chances of survival, breast cancer surgery can lead to the development of lymphedema – a condition that causes swelling of the limbs due to the accumulation of fluid after the removal of lymph nodes and in breast cancer, lymph nodes are removed from the armpit. Upper limb lymphedema affects about a third of patients undergoing surgery. The risk increases if the patient has to receive radiation further. There are many surgeries that have been invented to prevent this kind of lymphedema.

The current trend toward breast cancer shows a higher diagnosis rate in younger women. Thus, if they develop lymphedema, the chances of having complications and infections (Lymphangitis) are relatively higher. Cosmetically, the limb appears bulky and ugly. In the last stages, the arm can develop Lymphangiosarcoma, a malignant condition that happens in a lymphedematous limb.

Prevention and Management of Lymphedema -

The key to reducing the risk of lymphedema is to try and prevent its occurrence if it occurs it should be picked up very early. Dr Mohammed Basheeruddin Inamdar, Consultant - Surgical Oncology, Manipal Hospital Old Airport Road, says, “The use of sentinel node biopsy instead of clearing the axilla can significantly reduce its risk from 30% to 6%. It is a less invasive method of detecting whether cancer has spread to the lymph nodes under the arm. If the result comes out negative, axillary lymph node dissection is not required, thereby avoiding the lymphedema almost in its entirety. However, when a comprehensive axillary lymph node clearance is performed in patients with axillary lymph node-positive, the chances of lymphedema development become very high (10 to 20%), especially during the clear up of the Level 3 lymph node. These patients require primary lymph-venous anastomosis in order to decrease the rates of lymphedema. This speciality is dealt with by our plastic surgery team where we identify lymphatics and veins during the axillary lymph node dissection and we keep them long and nicely clipped.”

Primary lymph-venous anastomosis is a surgical procedure that connects cut lymphatics from the arms to small blood vessels of the vein in the axilla. This connection prevents further lymphedema development by reducing the accumulation of fluid and reduces the risk of lymphedema from 30% to 6-7%, which is very good for these patients. Primary reconstruction of the breast is another way to prevent lymphedema. Lymph nodes can be transferred from somewhere else in the body to the axilla during breast reconstruction. These preventive measures can help reduce the risk of lymphedema and improve the patient's quality of life.

Lymph ICG scanning or screening of lymphedema by doing ICG scans can detect lymphedema and determine its severity depending on its stages. Dr Ashok B C, Consultant - Plastic, Reconstructive, and Cosmetic Surgery, Manipal Hospital Old Airport Road, says, “In the early stages of lymphedema, we can reduce the lymphedema by doing certain exercises and manual lymphatic drainage and giving the patient some kind of compression garments. In early stage 2 and stage 3, bypasses can be done to reduce oedema that has already accumulated. In stage 3, lymph nodes from somewhere else in the body can be transferred to the affected area, and these lymph nodes will take up the action of the old lymph nodes and reduce the lymphedema. In cases where lymphedema has been there for a long period of time and has developed into stage 4, the only option is either liposuction or lymph-suction, or excisional procedures like removing certain parts of the skin and affected tissue."

Despite advancements in treatment, lymphedema remains a challenging condition to manage. Thus, the focus should be on preventing the disease from happening because even with all these kinds of surgery, most of the time, the lymphedema might not completely get reversed. Patients may feel better as the complications get relieved and the progression reduces, but some amount of excess fluid will remain for a lifetime.