What Is Lymphedema?
Lymphedema is a condition where there is persistent swelling because of a problem with the lymphatic drainage of that area. This most commonly occurs in the arms or legs but can occur in other areas like the breast. We all have three types of blood vessels in our body: arteries, veins and lymphatics. Arteries bring blood into an area while veins bring blood out. The lymphatic vessels help drain the excess fluid not carried by the veins and also help with immune function.
What Causes Lymphedema?
There are two basic types of lymphedema. In primary lymphedema, we don’t know what the cause is. Patients with primary lymphedema may have swelling that started at birth, during childhood or at any point in their adult life. In secondary lymphedema, the lymphedema occurs secondary to something else. The most common cause of secondary lymphedema is removal of lymph nodes for cancer. For example, a patient with breast cancer who had axillary (armpit) lymph nodes removed may develop lymphedema of their arm. A patient with melanoma in their foot, leg or thigh who had groin lymph nodes removed may develop lymphedema of their leg. It is thought that the lymphatic vessels, which usually pump the lymph fluid up back toward the heart, become firm and scarred from the blockage upstream, allowing the fluid to pool out into the surrounding tissue.
What Are Treatments For Lymphedema?
Lymphatic massage and compression are an important part of any treatment for lymphedema. In conjunction with these treatments, we are fortunate to be able to offer a variety of surgical approaches that can help to reduce the severity of the lymphedema, lightening the feeling of your arm or leg and potentially make it easier for you to move or perform activities of daily living.
In lymphedema liposuction, we perform circumferential liposuction of either the arm or the leg. It is important to note that the patient must wear compression both before and after the surgery. This outpatient procedure works well with longstanding results in patients with both primary and second lymphedema.
Lymphedema Mass Excision
Some patients, especially those who have lost a significant amount of weight, will have a mass of tissue or “ball” hanging from the inside of their thighs. This ball of tissue can make it hard for them to move or even walk. In lymphedema mass excision, we remove that ball of tissue in the operating room. Patients may be able to leave the same day or stay 1-2 days in the hospital, depending on their overall health. This operation can mean the difference between being wheelchair-bound and being able to walk unassisted.
Lymphatico-Venous Anastomosis (LVA)
In a LVA procedure, the surgeon finds the remaining healthy portion of the lymphatic vessel and connects it using supermicrosurgery (under a microscope) to a similarly sized vein. One way to imagine this surgery is like a bypass on a highway. The vein is like the main road and the lymphatic vessel is like the service road, both heading in the same direction. If there is a blockage in the lymphatic vessel or service road, we can build a bypass or make a connection to the vein or main road.
Lymph Node Transfer
In lymph node transfer, the surgeon takes lymph nodes from another part of the body (most commonly, the lower abdomen) and moves that to an area that lymph nodes have been removed, like the armpit or groin area. The blood vessels from the collection of lymph nodes are connected to new blood vessels using a microscope. This procedure does two things. First, by releasing the tight scar and putting healthy tissue in this area, we allow the flow to be re-opened and release any limited range of motion. Second, the new lymph nodes over time send out signals recruiting and regrowing new lymphatic vessels.
Many of the procedures above can be combined. For example, it is possible to combine a LVA and lymph node transfer in one procedure. Patient can also undergo a simultaneous breast reconstruction with a lymph node transfer as part of the same operation.
Schedule My Consultation
If you’re ready to schedule your lymphedema surgery or simply want to learn more about the procedure, our doctors can give you the answers and reassurance you need to make the decision that’s right for you. To schedule your private consultation, call 212-628-7300.