Ayestaray Benoit, Chrelias Theodoros
From the Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris Sud XI, Evry, France.
Ann Plast Surg. 2018 Dec;81(6):679-681. doi: 10.1097/SAP.0000000000001560.
Breast lymphedema is a common issue after breast cancer surgery but remains understudied because it is difficult to be quantified. Untreated breast lymphedema may lead to severe form of delayed breast cellulitis. Supermicrosurgical lymphaticovenular anastomosis is one option for the treatment of breast cancer-related lymphedema but has not been described for the treatment of breast lymphedema.
This report presented a rare case of male breast lymphedema secondary to axillary lymph node dissection for the treatment of a forearm melanoma. Deep lymphatic vessels and adjacent venules were individualized under high magnification in the periareolar area. Six lymphaticovenular anastomoses were performed using supermicrosurgical techniques. A clinical examination and a volume assessment under magnetic resonance imaging were used to assess the efficiency of surgery.
Postoperative outcome was uneventful. The patient was followed-up during 1 year. Swelling relief was clinically significant 3 months postoperatively. The pinch test reduction was 2 cm after 12 months. The breast volume reduction rate was 47.2%.
Supermicrosurgical lymphaticovenular anastomosis may be efficient for the treatment of postoperative breast lymphedema, even in male patients.
乳腺癌手术后，乳房淋巴水肿是一个常见问题，但由于难以量化，其研究仍不充分。未经治疗的乳房淋巴水肿可能会导致严重的迟发性乳房蜂窝织炎。超显微外科淋巴管静脉吻合术是治疗乳腺癌相关淋巴水肿的一种选择，但尚未见用于治疗乳房淋巴水肿的报道。
本报告介绍了一例罕见的男性乳房淋巴水肿病例，该病例继发于因治疗前臂黑色素瘤而进行的腋窝淋巴结清扫术后。在乳晕周围区域，在高倍显微镜下分离出深部淋巴管和相邻的小静脉。采用超显微外科技术进行了6例淋巴管静脉吻合术。通过临床检查和磁共振成像下的容积评估来评估手术效果。
术后恢复顺利。对患者进行了1年的随访。术后3个月，肿胀缓解具有临床意义。12个月后捏压试验减少了2厘米。乳房体积缩小率为47.2%。
超显微外科淋巴管静脉吻合术可能对治疗术后乳房淋巴水肿有效，即使是男性患者。
