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Microsurgical procedure relieves common complication of breast cancer treatment

Rachel Jackson's wish was simple: to wear her wedding ring on her left hand again.

Her left arm, hand and fingers were swollen as a result of lymphedema, a relatively common and painful complication following lymph node removal or radiation treatment. In 2010, Jackson had a double mastectomy for stage 2 breast cancer. Her surgeon also removed 36 lymph nodes on her left side.

Over the next couple of years, the swelling "got progressively worse even though I had physical therapy and wore compression garments," said Jackson, 37.

David W. Chang, MD

Jackson turned to surgeon David W. Chang, MD, now a plastic and reconstructive surgeon at the University of Chicago Medicine. Chang, who at the time was at MD Anderson Cancer Center in Houston, had performed Jackson's breast reconstruction. He explained that a procedure called lymphovenous bypass might alleviate some of her symptoms. Chang is one of only a few surgeons in the U.S. who routinely perform the complex procedure.

The surgery involves injecting a green dye that illuminates the lymphatic vessels as Chang views them with a sophisticated infrared camera. He traces the vessels on the skin and then makes several tiny incisions to reach them. Using microsurgical tools, he makes cuts in the vessels and nearby veins and then sews them together to bypass areas that have built-up fluid. As the lymph flows more freely, the swelling goes down.

"When they took measurements a few months later, my left arm was the same size as my right."

The surgery is more effective in the earlier stages of lymphedema and for swelling in the arms than in the legs. The procedure takes about four hours, and most patients go home within 24 hours. The surgery leaves small scars where the incisions were made, but few other side effects are likely.

As many as 25 to 30 percent of women who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema. While there is no cure, lymphovenous bypass and lymph node transfers can be effective in relieving pain, swelling and discomfort.

"Before we had these skills and tools, there wasn't much to do for lymphedema," Chang said. "Now there are options for these patients."

Chang and his colleagues studied 100 consecutive patients who had lymphovenous bypass surgery and found that overall, surgery reduced the excess volume of affected limbs by 33 percent after three months; 36 percent after six months; and 42 percent after one year.

Jackson had the surgery in April 2013, in Houston. "When they took measurements a few months later, in July, my left arm was the same size as my right," she said. Chang added, "It's very rewarding to see this kind of result."

Today, Jackson's wedding ring is back in its rightful place, on her left hand.