Microsurgery offers treatment and prevention options for breast cancer patients in the Baltimore-Washington, D.C., area.
When a woman undergoes treatment for breast cancer, sometimes lymph nodes in the armpit are damaged or need to be removed. This can disrupt the flow of lymphatic fluid, preventing it from draining as it normally would. The result is a backup of fluid that can cause severe, debilitating swelling in the arm, a condition called lymphedema.
Innovative microsurgical procedures finally provide a real solution
Until recently, physicians were only able to help manage the symptoms of lymphedema post mastectomy. But we now have exciting surgeries that get to the root of the cause to treat and even prevent the condition.
These procedures, called Lymph Node Transfer and Lymphovenous Bypass, have shown great success, but are not yet widely available. The members of our MedStar Health lymphedema surgery team are some of the only surgeons on the East Coast to perform them. As leaders in the treatment of lymphedema and pioneers in prevention, we look forward to helping you continue to enjoy the daily activities you love.
Signs and symptoms
Lymphedema can manifest months, years, or even decades after the initial cancer treatment.
Symptoms in the arm may include:
- Swelling and skin tightness
- Heaviness or joint stiffness
- Debilitating tingling or numbness
- Pain or redness
- Thickened skin
- Tighter-fitting shirts, watches, or rings
If left untreated, the swelling caused by lymphedema can become disfiguring. Patients may also be susceptible to bacterial or fungal infections of the skin.
Risk factors
Not everyone who has their lymph nodes removed will develop lymphedema. Experience shows 20% of women who undergo breast cancer treatment will be affected by the condition. Certain factors—including personal characteristics or type of treatment—can elevate your risk. For example, some women experience lymphedema in the breast after radiation. Our lymphedema team will work directly with your mastectomy surgeons to determine your individual risk.
Contributing factors include:
- A large amount of lymph nodes removed
- Combined surgery and radiation therapy
- Combined radiation and chemotherapy
- Obesity
- Smoking
- Infection
What is Lymphovenus Bypass (LVB)?
Utilized for patients in early stages, lymphovenous bypass is a relatively minor procedure performed through a small incision. The small lymphatic vessels are divided and redirected through the nearby venous system, helping reestablish a proper flow. The procedure is an outpatient surgery and patients can typically go home on the same day.
In more severe cases, liposuction may also need to be performed. This surgery uses a cannula to remove the extra swollen tissue and fat that’s behind lymphedema.
What is Lymph Node Transfer?
In this procedure, the surgeon uses specialized microsurgical techniques to transfer lymph nodes from the abdomen or clavicle areas to the armpit. If a single or double mastectomy patient is considered at risk for lymphedema, this procedure can be coordinated with and performed at the same time as breast reconstruction. Patients stay overnight after the procedure, then go home the following day.
Meet our physicians
As pioneers of these innovative procedures, our physicians are also some of the most experienced surgeons performing them. Get to know our passionate, committed doctors that specialize in lymphedema.
Gabriel Del Corral, MD
Plastic Surgery
Kenneth Fan, MD
Plastic Surgery
Rajiv Parikh, MD, MPHS
Plastic Surgery
David Song, MD, MBA
Plastic Surgery
Laura K. Tom, MD
Plastic Surgery
Hear Susan’s story: Lymph node transfer after breast reconstruction
“There are other options, don’t stop living your life and find out what is available. I’m just grateful this was an option available to me.” – Susan Wolfe-Tanks
Access to leaders in breast cancer care
As part of MedStar Health, our lymphedema team offers access to the largest health network in the region, including premier breast cancer specialists. Working together, we’ll develop a treatment plan personalized to you and your needs.
FAQs
Explore the answers to common questions from our patients.
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Could I benefit from these procedures?
Patients who present with chronic, non-pitting edema caused by excessive fibrosis/adipose tissue deposition are considered ideal candidates for these procedures.
Those who are about to undergo surgery for breast cancer and have potential risk factors may be considered candidates for preventative lymphovenous bypass. Should a determination be made that this is the best course of action for you, the procedure can be performed at the same time as your lumpectomy, mastectomy, or breast reconstruction.
Lymphovenous bypass is compatible with a variety of breast reconstruction procedures, including DIEP flap and TRAM flap techniques.
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Are there ways for patients to prevent lymphedema after mastectomy?
If they are determined at risk for lymphedema, cancer patients have some preventative options available. While not all risk factors are avoidable, smoking cessation and weight loss are two ways to help prevent edema after mastectomy.
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How long will it take to see results?
Expect to see results immediately, as the swelling will greatly reduce at first. Since lymph nodes are typically still dormant at the time of diagnosis and treatment, the arm may swell in the future, however, as they start functioning properly again, the swelling will recede once more.
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What can I expect during recovery from Lymphovenous Bypass (LVB)?
For best results, it is recommended you complete pre-operative therapy with a certified lymphedema therapist for four to six weeks prior to your surgery.
After surgery, the following guidelines are recommended:
First two weeks
- Avoid pressure or compression to incision site
- No lifting, pushing, or pulling greater than 10 pounds
- Can perform manual lymphatic drainage to the incision, but not over incision site
- Ok to use kinesiology tape
After two weeks:
- Resume lymphedema therapy at two weeks post-operation
- Can resume compression (avoid tourniquet effect over incision site)
- Can resume manual lymphatic drainage and/or use of Flexitouch®
After four weeks:
- No weight bearing or lifting restrictions
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What can I expect during recovery from Lymph Node Transfer?
For best results, it is recommended you complete pre-operative therapy with a certified lymphedema therapist for four to six weeks prior to your surgery.
After surgery, the following guidelines are recommended:
First two weeks:
- Resume use of compression immediately post-op
- Avoid pressure to the incision site
- Avoid lifting, pushing, or pulling more than ten pounds
After two weeks:
- Resume lymphedema therapy after two weeks, or once drains have been removed
- Resume manual lymphatic drainage and/or use of Flexitouch®
After four weeks:
- Can lift greater than ten pounds
- Begin progressive return to activity
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What if I don't live near these hospitals?
We proudly treat patients from all over the country—and world. Get in touch to see how we can help you.
Locations near you
MedStar Georgetown University Hospital
3800 Reservoir Rd. NW,
Washington, DC 20007
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MedStar Washington Hospital Center
110 Irving St. NW,
Washington, DC 20010
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MedStar Franklin Square Medical Center
9000 Franklin Square Dr.
Baltimore, MD 21237
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For Referring Physicians
If you are caring for a patient who requires treatment, we encourage you to refer them to our practice. We value your partnership and are committed to ongoing collaboration with you to bring your patient the attention they need.
Our Patient Referral Liaison Jane Hanna, RN, OCN, is available to assist with personalized coordination of care and expedited appointment scheduling. Jane can provide support with all aspects of service—from diagnosis to treatment to follow-up. With over 30 years of oncology nursing experience, her way of working is patient and caregiver-focused with an emphasis on education and empowerment.