Modern surgical approaches to prevention of upper limb lymphedema after treatment of breast cancer

Objective. To evaluate current surgical methods for preventing upper extremity lymphedema after breast cancer surgery with emphasis on immediate lymphatic reconstruction (ILR), including supermicrosurgical lymphovenous anastomosis (LVA) and other innovative approaches. Material and methods. We analyzed literature and clinical data on prevention of primary lymphedema including lymphatic microsurgical preventing healing approach (LYMPHA), LVA, lympholymphatic anastomosis (LLA), vascularized lymph node transplantation, and transplantation of lymphointerposition flap. Results. ILR reduced the incidence of lymphedema to 4-16% compared to control groups (up to 35%). LYMPHA is the most effective method. In our patients, there were no complications, and mean time of supermicrosurgical stage was 57 min. Conclusion. Immediate lymphatic reconstruction is a safe and effective method for preventing lymphedema. However, further prospective studies with control group and long-term follow-up are needed to develop standard guidelines. Optimal use of these methods is possible with risk stratification and careful patient selection.