Breast reconstruction - DIEP flap with lymph node transfer

What is lymph node transfer surgery?

Lymph node transfer surgery is a relatively new and significant option for the management of lymphoedema. 

If lymph nodes are removed from under the arm as part of breast cancer surgery, the normal drainage of lymph may be affected and this may cause the arm to swell, sometimes permanently which is called lymphoedema. Lymph nodes with a blood supply can be transferred from spare lymph nodes in the groin area. This can dramatically improve or cure the arm lymphoedema and there is no risk of swelling to the lower limb where the spare nodes are harvested from. 

Vascular lymph node transfer can be done simultaneously with DIEP breast reconstruction or as a stand-alone procedure for lower limb lymphoedema or arm lymphoedema when a breast reconstruction is not required. If done in conjunction with a DIEP breast reconstruction, the lymph nodes are taken in continuity with the DIEP flap, so that they receive their blood supply through the flap itself. If the lymph nodes are used in isolation then they are harvested with a supplying artery and vein which is plumbed into vessels in the vicinity where they are being transplanted. 

The procedure adds very little to a standard DIEP flap procedure time. If it is performed in isolation then it is a 3-4 hour procedure with several days in hospital. There are minimal side effects from harvesting the nodes and most importantly there is no risk of lower limb lymphoedema. 

Whilst this is a relatively new procedure and few units in the world are offering this, we have to date performed this on 30 patients to date and they have all had improvement of their symptoms with minimal side effects. In a questionnaire study all patients have shown significant improvement in their quality of life, function and symptoms and say that they would recommend it to a friend. 

Author: Miss Anne Dancey, Consultant Plastic Surgeon practising at BMI The Priory & Edgbaston Hospitals

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