Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru.
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA.
Microsurgery. 2022 Sep;42(6):617-621. doi: 10.1002/micr.30939. Epub 2022 Jul 12.
Breast cancer-related lymphedema following axillary lymph node dissection (ALND) has been documented in 6%-55% of patients, mostly occurring within the next 3 years after radiation or surgery. We present a case of a 53-year-old patient with hormone positive, stage IB, left breast invasive ductal carcinoma treated with immediate lymphatic and microvascular breast reconstruction (MBR) using vascularized lymph node transfer (VLNT) for lymphedema prevention. A deep inferior epigastric perforator (DIEP) flap (18.3 × 11.2-cm) and simultaneous prophylactic gastroepiploic-VLNT (7 × 3-cm), orthotopically inset in the axilla, were used for reconstruction following mastectomy and radical ALND. The procedure was uneventful. The patient did not display increased postoperative arm circumferences. ICG lymphography did not show any changes at 2- and 3-years after surgery. Preventive lymphatic reconstruction with GE-VLNT and immediate MBR using the DIEP flap offers a new possibility for the primary prevention of lymphedema and simultaneous immediate autologous breast reconstruction without the risk of iatrogenic lymphedema. Further studies will be directed to unveil the external validity of these findings and the risk reduction rate of this approach.
乳腺癌相关的腋窝淋巴结清扫（ALND）后淋巴水肿已在 6%-55%的患者中得到证实，大多发生在放疗或手术后的 3 年内。我们报告了一例 53 岁的患者，患有激素阳性、IB 期、左侧乳腺浸润性导管癌，采用带血管化淋巴结转移（VLNT）的即刻淋巴和微血管乳房重建（MBR）预防淋巴水肿。在乳房切除术和根治性 ALND 后，使用 18.3×11.2cm 的腹壁下动脉穿支皮瓣（DIEP）和同时预防性胃网膜 VLNT（7×3cm）进行重建，原位植入腋窝。手术过程顺利。患者术后手臂围度没有增加。ICG 淋巴造影在术后 2 年和 3 年均未显示任何变化。预防性胃网膜 VLNT 和使用 DIEP 皮瓣的即刻 MBR 进行淋巴重建为原发性淋巴水肿预防和同时即刻自体乳房重建提供了一种新的可能性，而不会增加医源性淋巴水肿的风险。进一步的研究将旨在揭示这些发现的外部有效性和这种方法的风险降低率。
