Simultaneous Vascularized Lymph Node Transfer With Microvascular Breast Reconstruction

Background:

Lymphedema is a common, progressive, and sometimes debilitating outcome from treatment of breast cancer.  Microvascular lymph node transfer has recently resulted in promising outcomes for patients with lymphedema.¹  One technique for combining microvascular breast reconstruction and lymph node transfer has been described.²  The purposes of this study are to describe an algorithmic approach to performing combined microvascular breast reconstruction with lymph node transfer and provide a preliminary analysis of the results.

Methods:

Patients with upper extremity lymphedema secondary to breast cancer treatment who have been dispositioned to free autologous reconstruction from the abdomen underwent simultaneous vascularized groin lymph node transfer. Flap design and inset were predesigned and adjusted as necessary given the intraoperative surgical findings.  Postoperative evaluation included qualitative assessment and quantitative analysis.

Results:

Twenty patients underwent simultaneous free abdominal-based breast reconstruction and vascularized groin lymph node transfer with a mean follow up of 9 months.  Patient demographics included an average age of 50 years old, an average body mass index of 30, an average of 3.7 years duration of lymphedema symptoms, and an average of 23 percent increased volume in the affected upper extremity.  All patients had successful breast reconstructions. Minor donor site complications occurred in 4 patients (20 percent) which resolved with conservative measures.  Twelve patients (60 percent) reported qualitative symptomatic improvement with these combined procedures.  The upper extremity mean volume differential reductions were 3 percent, 8 percent, and 12 percent; at 1, 3, and 6 months, respectively.

Conclusions:

We present our algorithm for flap design and inset.  Early results of microvascular breast reconstruction combined with lymph node transfer shows promise for patients with lymphedema after treatment of advanced breast cancer. Long term studies may be warranted.