Breast cancer related lymphedema and surgical treatment

Lymphedema is a chronic, progressive and debilitating disease. This review article focuses on surgical treatment of breast cancer-related lymphedema especially in perspectives of microsurgical options. In the early stage, where protein-rich fluid accumulates, expressed as pitting, conservative treatments, such as complex decongestive therapy and/or one of the physiologic treatments, lymphovenous bypass (LVB) can be considered. Once the stage is more advanced and skin fibrosis and adipose tissue deposition are appearing, it may be considered to attempt vascularized lymph node transplant (VLNT) alone or VLNT and LVB simultaneously. If the stage is more advanced and fibroadipose tissue accumulation is dominant, then debulking procedure such as lipo-suction may be considered. A direct excision may be needed for the most advanced stage of lymphedema.