Immediate Lymphatic Reconstruction

For many breast cancer patients, lymphedema is a feared side effect that causes life-disrupting symptoms, including fluid buildup, inflammation, pain, infection, and swelling that can bring arms or legs to three to four times their normal size. Lymphedema affects up to 40 percent of those undergoing an axillary lymph node dissection. In lower extremity cancer surgery, the same issues can arise in the legs when inguinal groin lymph nodes are removed.

Immediate Lymphatic Reconstruction

At Fox Chase Cancer Center, Michael Tecce, DO, Assistant Professor in the Department of Surgical Oncology and fellowship-trained in complex reconstructive microsurgery, offers a unique approach to lymphedema prevention. Tecce performs an advanced microsurgical procedure, known as immediate lymphatic reconstruction or immediate lymphovenous bypass, during breast or other cancer surgeries. This procedure, which is not widely available, has shown promising results in preventing lymphedema before it starts.

Tecce says, “Since the surgical oncologist is removing the lymph nodes, everything I need to work with is there to implement this prophylactic approach.” Using a super-high-magnification microscope with infrared and fluorescein filters, Tecce locates the tiny non-working lymphatic channels—each less than 1mm in diameter—and surgically bypasses them, rerouting lymphatic fluid into a viable venous network. It is a highly technical procedure requiring years of special training, which few centers nationwide perform, and Fox Chase is the only cancer center in the region to offer it.

Treating Earlier-Stage Lymphedema

For patients with pre-existing lymphedema, Fox Chase offers a delayed approach to treating this disease with a variety of surgical options that are tailored to each patient’s specific clinical picture. If a patient is a candidate for a bypass, this procedure uses the same techniques as in the immediate setting and is performed through a small, paper-cut incision as an outpatient procedure. It provides an alternative for patients who may not be suitable candidates for immediate bypass, offering them a chance to reduce lymphedema symptoms.

Even Managing Late-Stage Lymphedema

Another category of lymphedema patients is those with long-term chronic disease, for whom simple tasks of daily living, such as brushing their teeth or combing their hair, has become impossible. For these individuals, Tecce offers interventions that can improve their quality of life and give them a sense of well-being.

“For patients without major medical comorbidities, I might advise a lymph node transplant, removing lymph nodes from one part of the body and transplanting them to the affected area. One site where I can safely remove nodes without the risk of creating further lymphedema is in the omentum, which is located in the abdomen,” says Tecce. “However, since this is a longer and more complicated procedure, the patient must be strong enough to undergo the surgery and recovery.”

However, Fox Chase offers solutions even for candidates whose health issues preclude a nodal transplant. “We are highly experienced in debulking procedures, liposuction, and removing excess skin, all of which help alleviate symptoms and increase a person’s function,” says Tecce.

Preventing lymphedema rather than tackling its symptoms later on is always advisable. However, since this may not be clinically possible for everyone, Fox Chase also provides patients with the most advanced techniques and technologies to help at any stage of this onerous condition.