Postoperative Lymphatic Patterns and Application of LVA in Breast Cancer Patients With Truncal Lymphedema.

Abstract

Upper extremity lymphedema occurs in 40% of patients following breast cancer treatments. In contrast, truncal lymphedema, a common complication of breast cancer treatment, is less understood and underreported. This study has 2 aims: (1) map lymphatic patterns of patients with truncal lymphedema and (2) describe our approach for the application of lymphovenous anastomosis (LVA) for truncal lymphedema and demonstrate the technical feasibility and potential clinical benefit. We retrospectively reviewed 95 patients (173 hemitrunks) following breast cancer treatment who underwent truncal ICG lymphography over 9 years. In 2 cases where conservative measures failed to provide relief, patients were treated with LVA placed inferior to the inframammary fold, directed by lymphographic findings. Dermal backflow was significantly worse in the superior trunk, above the inframammary fold (P < 0.001). Diffuse or absent superficial lymphatic channels were observed in 84% of mastectomy skin flaps. Lymphatic drainage was visualized to the ipsilateral axilla (40%), ipsilateral groin (66%), and contralateral trunk (26%). LVA can be used for surgical treatment of truncal lymphedema when conservative measures are insufficient. Patients treated in our practice had complete relief of symptoms by 12 months with reduced conservative management use, Lymphedema Life Impact Score, and number of infections per year. This work demonstrate that detailed lymphatic mapping enables targeted LVA planning and may offer an effective surgical option for managing breast cancer-related truncal lymphedema.