The Center for Lymphedema SurgeryDr. Russell Ashinoff, director of The Center for Lymphedema Surgery at The Institute for Advanced Reconstruction, is passionate about increasing awareness about the surgical treatment options available for lymphedema. Along with Dr. Eric I. Chang, they are among the few physicians in the world currently offering advanced surgical options for the treatment of lymphedema. The goal of these procedures is to increase patients’ quality of life by improving or alleviating the symptoms of lymphedema.
Hope for Lymphedema
Lymphedema is a chronic condition that often manifests as an abnormal buildup of fluid, causing swelling, most commonly in the arms or legs. This swelling may be present since birth or develop without a known reason. Lymphedema can also occur after radiation or certain cancer-related surgeries. Initially reversible, lymphedema typically progresses to irreversible, restricting range of motion and limiting everyday activities.
For many years, the only treatment options available for lymphedema were decompressive massage, wrapping and compression. Fortunately, cutting-edge surgical interventions are now available for patients with lymphedema.
Surgical Procedures offered at The Institute for Advanced Reconstruction
Lymphaticovenous anastomosis (LVA) is an advanced microsurgical procedure designed to create alternate routes for excess lymphatic fluid to exit the affected limb.
Free Lymph Node Transfer
During this procedure, lymph nodes are harvested from one area of the body and transferred to the area of lymph node deficiency, improving drainage of the affected limb. The lymph nodes are mapped prior to surgery to avoid causing lymphedema at the donor site.
Lymphedema liposuction is a minimally invasive technique in which we remove excess fat and scar tissue. This procedure is often done in conjunction with lymphaticovenous anastomosis (LVA) or free lymph node transfer.
Lymphedema Mass Excision
Some patients have a large mass hanging from the inside or outside of their thigh which is related to lymphedema. This mass can be surgically removed, which makes it easier to walk and move your leg again.
Breast Reconstruction and Lymphedema Surgery
If you’ve had a mastectomy and a diagnosis of lymphedema, it is possible to perform breast reconstruction at the same time as a lymphedema procedure.
Our advanced procedures have the potential to significantly improve symptoms, quality of life, and in some cases, eliminate the need for ongoing compression or therapy while reducing the rate of infection. Some patients are walking or working again after years of disability. Others have seen their lymphedema effectively eradicated.
The Center for Lymphedema Surgery is one of a few centers in the world to perform innovative and life-changing surgeries for lymphedema. We offer an individualized approach to treatment, precisely fine-tuning each procedure to attain desired results.
There’s hope for treating lymphedema. Contact us today to schedule a consultation.
Q & A with Our Specialists
Q:Lymphedema can be a result of breast cancer surgery. As a reconstructive surgeon, what have been your observations of lymphedema among breast cancer patients?
Lymphedema is something unexpected that can go on for years, even after the cancer has been treated and cured. It can be very physically and mentally debilitating for patients. They often feel uncomfortable and embarrassed. The compression garments, which apply pressure to the affected limb in order to keep the lymph fluid flowing in the proper direction, have to be worn full time, even in the summer. Adding insult to injury, wearing a compression garment on the arm (where lymphedema can occur following breast cancer surgery) presents further challenges than the leg. It’s like wearing a long pair of gloves to do all of your everyday tasks, which is quite difficult.
Q:What are the different types of lymphedema and which do you treat?
There are two types of lymphedema: primary lymphedema and secondary lymphedema. Primary lymphedema has no known direct cause, but relates to inherited problems with the lymph vessels. Secondary lymphedema develops as a result of another condition or treatment that damages the lymph nodes or lymph vessels. Secondary lymphedema may develop after cancer and cancer treatment, infection, trauma, or obesity.
One of the most common causes of secondary lymphedema is surgery for the treatment of cancer. These surgeries may include removal of or damage to sections of the lymphatic system. Lymphedema can occur in the arms when lymph nodes from the underarm, called axillary lymph nodes, are damaged or removed for the treatment of breast cancer. Secondary lymphedema can also occur in the legs as a result of surgery for melanoma. This surgery may include removal or damage of lymph nodes in the groin, called inguinal lymph nodes.
We treat all kinds of lymphedema. By assessing each individual patient’s lymphedema diagnosis, we are able to determine the best course of treatment.
Q:What types of surgery are offered at The Institute for Advanced Reconstruction?
To date, although there is no consensus on surgical procedures and protocol, refinements in microsurgical techniques and improved methods have led to the establishment of a standard surgical treatment for lymphedema.
We offer four types of procedures. The simplest is liposuction to reduce the weight and circumference of the affected limb. Liposuction can also be done in conjunction with the other procedures (discussed below) to further augment the results. However, with liposuction alone, people still have to wear the garment afterwards.
Lymphaticovenous Anastomosis (LVA) is a procedure done in order to improve the fluid drainage. In this procedure, the distal lymphatics are anastomosed or connected to small superficial veins, creating a “bypass” for the lymphatic fluid into the venous system.
The other procedure is free lymph node transfer, also known as Vascularized Lymph Node Transfer. In this procedure, lymph nodes from the groin or chest wall are isolated with their blood supply and microsurgically transferred to the arm or groin, where the lymph nodes are not functioning.
Lymphedema mass excision is a procedure done to surgically remove a large mass hanging from the inside or outside of a patient’s thigh which is related to lymphedema. Following this surgery, it becomes easier for patients to walk and move their leg.
We do all of these procedures as needed. Sometimes, LVA and lymph node transfer can be done together. These two procedures can also be combined with breast reconstruction surgery. Every patient is unique, so each person is individually assessed. We take each patient through a detailed evaluation to determine which procedure is best. The choice depends on a number of factors, including the patient’s medical history, his/her lymphatic anatomy and what makes sense for his/her life and lifestyle.
Q: What has been your general outcome for these surgeries?
I think the overall patient satisfaction speaks for itself. It is very high. These procedures have been done for at least 15 years. Now, there’s a better understanding of getting the surgeries more consistently successful.
Q:Often in your practice, you get the frustrated patients who have long heard the medical community tell them “just live with it” about various conditions. Why is it important not to take this as the only option for lymphedema?
No cure for lymphedema currently exists, so people can feel hopeless. It can be very moving for patients to realize there is something they can do about this problem that was once deemed unsolvable. This is revolutionary for them.
Q:Who makes a good candidate for this surgery, and how should a potential candidate go about being evaluated?
Someone has to be a good candidate for surgery in general. Significant medical problems would prevent lymphedema surgery. Otherwise, we carefully review patients on a case-by-case basis.
Essentially, our approach to the patient with lymphedema begins with a highly individualized analysis that combines advanced diagnostics with an array of treatment options. First, we typically spend up to an hour with a patient during their initial consultation, taking a detailed history, performing a physical exam with limb circumference measurements and photographs. The choice for the particular surgical option depends on both the patient’s anatomy and his or her treatment goals. In terms of being evaluated, if someone lives outside the area, initially we can speak over the phone. Ideally, however, it is best for people to make an appointment so we can see them in person.
Q:What is in the future/on the horizon for lymphedema surgery?
We are actively doing research to look into procedures that may prevent lymphedema for patients who undergo cancer surgery.