• Sheldon Feldman, Hannah Bansil, Jeffrey Ascherman, Robert Grant, Billie Borden, Peter Henderson, Adewuni Ojo, Bret Taback, Margaret Chen, Preya Ananthakrishnan, Amiya Vaz, Fatih Balci, Chaitanya R Divgi, David Leung, and Christine Rohde.
• Division of Breast Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, Columbia University, New York, NY, USA, sf2388@cumc.columbia.edu.
• Ann. Surg. Oncol. 2015 Oct 1; 22 (10): 3296-301.

BackgroundAs many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic-venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009.MethodsLYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve. Follow-up was with pre- and postoperative lymphoscintigraphy, arm measurements, and (L-Dex®) bioimpedance spectroscopy.ResultsOver 26 months, 37 women underwent attempted LYMPHA, with successful completion in 27. Unsuccessful attempts were due to lack of a suitable vein (n = 3) and lymphatic (n = 5) or extensive axillary disease (n = 1). There were no LYMPHA-related complications. Mean follow-up time was 6 months (range 3-24 months). Among completed patients, 10 (37%) had a body mass index of ≥30 kg/m(2) (mean 27.9 ± 6.8 kg/m(2), range 17.4-47.6 kg/m(2)), and 17 (63%) received axillary radiotherapy. Excluding two patients with preoperative lymphedema and those with less than 3-month follow-up, the lymphedema rate was 3 (12.5%) of 24 in successfully completed and 4 (50 %) of 8 in unsuccessfully treated patients.ConclusionsOur transient lymphedema rate in this high-risk cohort of patients was 12.5%. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.

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