Lymphedema Surgery

Lymphedema is the build-up of fluid in soft body tissues when the lymph system is damaged or blocked. The lymph system is a network of lymph vessels, tissues, and organs that carry lymph throughout the body. Lymphedema occurs when lymph is not able to flow through the body the way that it should, this can occur on its own or because of cancer or cancer treatments.

Our comprehensive team of lymphedema specialists includes therapists, radiologists and fellowship-trained microsurgeons. With this expertise, we offer patients modern screening and mapping in the form of indocyanine Green (ICG) lymphography to help them make decisions regarding surgery to improve their symptoms. Surgical treatment options include lymphovenous anastomosis, lymph node transfer and liposuction.

Screening and lymphatic mapping

Patients at high risk of developing lymphedema after lymph node excision or radiation treatment are examined using Indocyanine Green (ICG) lymphography performed by a specially trained lymphatic surgeon in our clinic. Patients with early lymphedema can undergo more minor surgery at an early stage to prevent the development of lymphedema. Those with normal scan results find can be reassured, although we offer repeated scans in the first three years after their surgery as this is the most frequent time that lymphedema may develop.

ICG lymphography uses a specialized lymphatic mapping probe to non-invasively map the lymphatic system in affected limbs in real-time. A trained lymphedema surgeon injects a small quantity of tracer into the hand or foot and then monitors the progress of the tracer through the lymphatic channels. The scan takes up to 45 minutes and the surgeon and patient can observe the function of their lymphatics directly.

Surgical options

Lymphovenous anastomosis
In cases where the ICG lymphography identifies residual patent lymphatic channels these can be identified by the surgeon in the operating room using a further scan and specialized microscope. It is then possible to divert these channels into small adjacent veins. This technique requires specialized training and instruments capable of joining vessels as small as 0.5mm in diameter, using sutures much finer than a human hair. Having performed this bypass procedure lymph fluid can flow away via the vein into the circulation, and no longer cause swelling in the arm. This procedure is a day-case operation and can be performed under local anesthesia in some cases.

Lymph node transfer
In cases where no residual channels can be identified, our surgeons can transfer healthy lymph nodes from the abdomen and plumb them into the affected limb. These transferred nodes act to absorb the excess lymph fluid in the limb and return it to the circulation. This procedure requires a longer stay in hospital normally of four days.

Liposuction
In advanced cases where lymph fluid has already turned to fat or scar tissue and cannot be drained by lymphovenous bypass or lymph node transfer, liposuction can be performed to reduce the size of the limb. This improves both the volume and symptoms of heaviness and pain.