Current concepts of lymphedema treatment for the breast cancer patient: a clinical practice review

Abstract

Lymphedema is a progressive disease caused by insufficient lymphatic drainage leading to abnormal accumulation of interstitial fluid within soft tissues. The most common cause for secondary lymphedema in the developed world is treatment for breast cancer. In the past, almost a forgotten disease, frequently overlooked, nowadays we can provide patients with treatment and relief. We discuss the current approach to lymphedema treatment for the breast cancer patient from clinical diagnosis through different imaging modalities with their advantages and disadvantages. Possible conservative and operational treatments aimed to restore lymphatic function and reduce adipose hypertrophy are described. From reductive techniques such as resection or liposuction to physiologic techniques involving reconstructive microsurgery such as lymphatico-venous anastomosis (LVA), vascularized lymph node transfer (VLNT) and other lymphatic free flaps. A review of our constructed approach and guidelines for managing secondary lymphedema in the breast cancer patient from 2005 to present days is presented. It is based on our growing experience and evolving techniques. Management of lymphedema in the breast cancer patient is multi-disciplinary and involves both the general and plastic surgeons, oncologists, physical therapists, social workers and many more. A holistic approach to the patient is advocated. This is best performed by adjusting and tailoring the appropriate treatment for each patient.