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Patient-specific surgical options for breast cancer-related lymphedema: technical tips

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Abstract
In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.
Author(s)
권진근박창식서현석홍대원홍준표
Issued Date
2021
Type
Article
Keyword
LymphedemaBreast cancer lymphedemaLymphaticovenous anastomosisLymph node transfer
DOI
10.5999/aps.2020.02432
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7555
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9785110&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Patient-specific%20surgical%20options%20for%20breast%20cancer-related%20lymphedema:%20technical%20tips&offset=0&pcAvailability=true
Publisher
Archives of Plastic Surgery
Location
대한민국
Language
영어
ISSN
2234-6163
Citation Volume
48
Citation Number
3
Citation Start Page
246
Citation End Page
253
Appears in Collections:
Medicine > Medicine
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