Poster Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Lymphatic surgery across the breast cancer treatment pathway: A narrative review (2100)

Jessica Vlok 1
  1. Te Whatu Ora, Auckland

Background
Breast cancer-related lymphoedema (BCRL) is reported in up to 61% of patients following axillary treatment.1 Lymphatic surgical techniques spanning preventive, reconstructive, and therapeutic strategies have emerged across the treatment pathway. This review summarises evidence at each stage of management.

Methods
A narrative review was performed, drawing on systematic reviews, meta-analyses and cohort studies to evaluate axillary reverse mapping (ARM), lymphovenous anastomosis (LVA), and vascularised lymph node transfer (VLNT) in preventive, reconstructive, and therapeutic settings.

Results
ARM, a lymphatic preservation technique, reduces the incidence of lymphoedema to 4.8%.2  Prophylactic LVA (LYMPHA) has been shown in long-term cohort data to reduce incidence to 1.5-2.5%.3  VLNT combined with autologous free-flap reconstruction achieves circumference reductions of 30-45%.4  For established BCRL, LVA and VLNT both demonstrate significant improvement over conservative therapy, with selection guided by lymphatic function and disease stage.5

Conclusion
Collectively, these findings support a stage-based approach, with preventive strategies reducing BCRL incidence and microsurgical techniques improving established disease. 

 

  1. Gennaro M, Maccauro M, Mariani L, et al. Occurrence of breast cancer-related lymphedema after reverse lymphatic mapping. Cancer. 2022;128(24):4185-4193.
  2. Co M, Lam L, Suen D, Kwong A. Axillary reverse mapping in the prevention of lymphoedema: a systematic review. Clin Breast Cancer. 2023;23(1)e14-e19.
  3. Boccardo F, Santori G, Fedre B, et al. LYMPHA technique to prevent arm lymphedema after breast cancer treatment: a 15-year follow-up. Ann Surg Oncol. 2026.
  4. Di Taranto G, Coleman GJ, Hardwicke J, Wallis KL, Skillman J. A comparative study between DIEP flap breast reconstruction and DIEP flap breast reconstruction coupled with vascularized lymph node transfer. Microsurgery. 2023;43(3):213-221
  5. Zeltzer A, Nistor A, Adriaenssens N, et al. Outcomes of LVA and VLNT in the combined surgical treatment of lymphedema. A Prospective Cohort Study. Plast Reconstr Surg. 2026;157(1):163-175