Evolution in Surgical Management of Breast Cancer-related Lymphedema: The MD Anderson Cancer Center Experience

Introduction: Lymphedema is a lifelong, debilitating condition that plagues a large portion of patients who have undergone multimodality therapy for breast cancer. With the increasing experience in supermicrosurgical treatment of lymphedema, reconstructive surgeons have made a tremendous impact in improving the quality of life of patients suffering from breast cancer related lymphedema. Methods: Historical review of our evolution in treatment and management of breast cancer related lymphedema and implementation of our new algorithm. Retrospective review of patients who have undergone both the lymphovenous bypass and vascularized lymph node transfer with autologous breast reconstruction. Results: The combined Breast Reconstruction Including Lymphovenous bypass and Inguinal to Axillary Node Transfer (BRILIANT) demonstrates promising outcomes. Thirty-eight patients (average age: 52.9 years, average BMI: 32.6 kg/m2) who have undergone the BRILIANT approach have all demonstrated improvements in their lymphedema. With an average follow-up of 19.1 months, no patients suffered a post-operative cellulitis, and 81.6% of patients also demonstrated a volume reduction. Conclusion: Our new algorithm combining breast reconstruction with lymphedema surgery represents an evolution in our approach to treatment of breast cancer related lymphedema has demonstrated promising results with long-Term outcomes.