The Impact of Vascularized Lymph Node Transfer in Reducing the Rate of Cellulitis in Breast Cancer-Related Lymphedema.

Abstract

Poorly managed breast cancer-related lymphedema may lead to recurrent cellulitis. Advances in the management of lymphedema have evolved beyond conservative decongestive therapy to include vascularized lymph node transfer (VLNT). In this article, the authors analyze the impact of VLNT in the reduction of upper extremity cellulitis in breast cancer survivors. The authors reviewed all patients at their institution who had breast cancer, underwent mastectomy, experienced upper extremity lymphedema, and proceeded with VLNT from 2017 to 2021. Patients were included if they had 1 or more episodes of cellulitis within the year before VLNT and were followed up for at least 12 months. The authors included 66 patients who fulfilled their strict inclusion criteria, with a median age of 57 years (interquartile range, 23 to 76 years). All patients were female, and most were White (88%), with a mean ± SD body mass index of 29.4 ± 6.7 kg/m 2 . Many presented with invasive ductal carcinoma (82%), had axillary lymph node dissection (98%), and received chemotherapy (94%) and radiation therapy (86%). VLNT was performed at a median of 92 months after mastectomy (interquartile range, 32 to 156 months). Overall, 58 (88%) patients remained infection-free with an infection rate decrease from an average of 2.27 before the index VLNT to 0.17 ( P < 0.0001) after VLNT. VLNT is associated with significantly decreased cellulitis rates. It should be considered as part of the treatment for infectious diseases of recurrent upper extremity cellulitis caused by breast cancer-related lymphedema with no adequate clinical improvement from conservative management alone.