Delayed Lymphatic Reconstruction for Breast Cancer-Related Lymphedema

Breast cancer-related lymphedema (BCRL) is a chronic disease that stems from damage to the lymphatic system due to breast cancer treatment leading to interstitial fluid buildup in the affected extremity. Patients with axillary lymph node dissection in combination with radiation therapy are at the highest risk of developing lymphedema. The mainstay non-surgical treatment involves participation in complete decongestive therapy with certified lymphedema therapists, daily compression garment usage, at-home pump treatments, and diligent skin care. Surgical treatments options can help alleviate symptoms associated with the disease by improving lymphatic drainage and removing fibrofatty tissue. Immediate lymphatic reconstruction (ILR) involves reconstructing cut lymphatics prophylactically at the time of axillary dissection with lymphovenous bypass (LVB) to decrease the risk of developing lymphedema. Delayed reconstruction addresses clinically diagnosed lymphedema and is divided into physiologic and debulking surgical techniques. Physiologic surgeries include lymphovenous bypass and vascularized lymph node transplantation (VLNT) aimed to treat fluid buildup. Debulking surgeries include lymphatic sparing liposuction or direct excision of fibrofatty tissues in the affected extremity to treat excess fibrofatty tissue secondary to lymphedema. This review discusses the pathophysiology of BCRL, diagnosis and staging of the disease, as well as provides an algorithmic overview on delayed lymphatic reconstruction options for BCRL.